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Eczema vs. Scabies: How They Differ

Posted on July 29, 2021
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
J. Christy McKibben, LPN

Eczema and scabies have some similar signs and symptoms, such as intense itching, scaly patches, and discolored, dry skin. Even though these conditions can give similar symptoms, their causes and treatments are very different. Scabies can be spread easily from person to person, whereas eczema is not a contagious condition. Scabies can also be cured through proper treatment. Eczema can be treated, but not cured.

According to the National Eczema Association, more than 31 million Americans (about 10 percent) are living with eczema. The World Health Organization reports that at any time, scabies affects more than 200 million people worldwide (about 3 percent).

Here, we will explore eczema and scabies, including their symptoms, causes, and treatment options. Talk to your doctor if you experience symptoms of either skin condition. They will be able to determine the cause of your symptoms and work with you to find the best way to manage them.

What Is Eczema?

Eczema, also known as atopic dermatitis, is an inflammatory skin condition characterized by discolored, dry, extremely itchy skin. It is not contagious, and there is not yet a cure. Because eczema is a chronic condition, people may experience periodical flare-ups, or times when symptoms appear or worsen. Seasonal allergies and asthma accompany these flare-ups for some individuals.

What Is Scabies?


Scabies (DermNet NZ)

Scabies is a highly contagious skin condition caused by skin mites. Scabies causes intense, itchy rashes. A person infected with scabies will develop thin, irregular tracks with a pimple-like, itchy rash. These rashes may also include scales and very small blisters or bumps.

What Causes Eczema and Scabies?

One of the biggest differences between eczema and scabies is the cause.

Eczema Causes and Risk Factors

Eczema is believed to be caused by a combination of an overactive immune system and a genetic variant that affects the skin’s protective barrier, allowing moisture out and germs in. People with a family history of atopic dermatitis, asthma, or allergies may have a greater chance of having eczema themselves. Food allergies may also be a potential trigger for eczema.

Young children are at greater risk of developing eczema than adults, though the condition can occur in people of any age.

Scabies Causes and Risk Factors

Scabies is caused by Sarcoptes scabiei (tiny mites that burrow into the top layer of a person’s skin to feed and lay eggs). The bugs, also known as human itch mites, are so small that the human eye can’t see them.

A more severe form of scabies is known as Norwegian scabies, or crusted scabies. A person with the more common type of scabies might have somewhere between 15 to 20 mites burrowed into their skin. With crusted scabies, however, hundreds to thousands of mites may be burrowed into the skin. People who develop crusted scabies usually have a medical condition and a weak immune system. This type of scabies develops because mites can multiply very quickly due to the lack of resistance in a person’s body.

Scabies is mostly spread through close physical contact between people. The transmission of scabies may also occur through infected bedding or clothing. The scabies mites can spread rapidly where there are many people gathered together in small areas, such as nursing homes, prisons, day cares, dormitories, and family homes.

Anyone can develop scabies, but people in poor living conditions have a much higher risk of contracting it. Elderly people, young children, and individuals with compromised immune systems are also at a higher risk of contracting scabies.

Signs and Symptoms of Eczema and Scabies

As different as their underlying causes are, eczema and scabies have many of the same signs and symptoms.

One of the closest similarities is that both conditions cause severe itching in most people. The itching causes many people to have intense discomfort that is worse at night, often leading to sleep loss. Both conditions can cause a person to have rashes and small, raised, sometimes pimple-like bumps or blisters. Scabies and eczema may also lead to scaly patches on the skin.

Due to the extreme itching, when an individual scratches the affected area, the bumps or pustules may leak. The leaking can cause crusting and also opens the person up to infections. If left untreated, infections can become serious, especially if bacteria gets into the bloodstream.

Despite the similarities, there are some differences in how scabies and eczema present themselves.

Eczema Symptoms

The signs and symptoms of eczema can vary greatly. The skin can be extremely dry and cracked, raw, and swollen. Patches may be red to brownish-gray, and over time, a person’s skin may become so thickened from scratching that it appears leathery and changes in color.

Eczema can occur in most places on the body, typically on the neck, inner elbows, hands, knees, ankles, feet, and around the eyes.

Scabies Symptoms

The scabies rash and blisters often look like narrow, irregular tracks in the skin. Scabies blisters may appear as hives, knots, or tiny bites under the skin. People with Norwegian scabies usually develop crusts that are widespread in one or more areas due to the number of mites that have burrowed into their skin. People with any form of scabies may not show symptoms for up to six weeks, but they can spread scabies even before those symptoms appear.

Scabies tends to show in the folds of a person’s skin. The most common areas that the burrow tracks appear include:

  • Finger webbing
  • Armpits
  • Waist
  • Insides of the wrists
  • Inner elbows
  • Soles of the feet
  • Around the breasts, genitals, and buttocks
  • Knees

Young children and infants will usually have the scabies rash on the soles of their feet, their scalp, or the palms of their hands.

Diagnosing Eczema vs. Scabies

The diagnostic processes for eczema and scabies may vary slightly. In both cases, a dermatologist will begin by asking about your symptoms and performing a physical exam to check for signs of different skin conditions.

Eczema Diagnosis

To diagnose eczema, the doctor may only need to examine the skin. A doctor will often also want to rule out other conditions that could be the cause of any signs and symptoms. Other conditions may be confused with eczema, including psoriasis, food allergies, or bacterial, fungal, or viral infections. Testing for other conditions may involve taking a skin biopsy or giving allergy tests, blood tests, or patch tests.

Scabies Diagnosis

Scabies is diagnosed when the doctor sees a characteristic burrow on the skin and scrapes the area to find a mite, egg, or fecal matter (known as scybala). The doctor will then look at the scraping under a microscope to identify the infestation and diagnose the condition. Because scabies spreads easily to close contacts, the doctor will ask if anyone else in the household also has an itchy rash.

Treatment Options for Eczema and Scabies

Because eczema is a chronic autoimmune condition, whereas scabies is caused by a mite, eczema and scabies must be treated with different approaches.

Eczema Treatments

There are many treatments and therapies available for managing the symptoms of eczema. Sometimes, regular moisturizing may be sufficient. Several medications may be prescribed, including corticosteroids and antibiotics. Eczema is often managed with topical medication. In cases where eczema is severe or widespread, a doctor may prescribe systemic medications like oral corticosteroids, immunosuppressants, or biologics.

It’s also recommended that people avoid triggers, such as certain soaps and lotions with dyes or fragrances. Bathing in lukewarm water for short amounts of time (instead of long, hot baths and showers) may help with some symptoms. Exfoliation is not recommended, and cleansers should be gentle. After bathing, pat dry and use a high oil content moisturizer on all of your skin to help lock in moisture.

Scabies Treatments

Treating scabies usually begins with scabicide medications, which kill the mites responsible for the condition. It is also important that anyone who has been in close contact with the infected person receives treatment to prevent reinfestation. Doctors usually recommend that entire families or close groups be treated when someone is diagnosed because of the likelihood of transmission by skin-to-skin contact.

Scabicides

Scabicide products, which must be prescribed by a doctor or dermatologist, are used to kill scabies mites. A scabicide prescription may direct an individual to leave lotions or creams on for hours, and some topical medications will need to be applied more than once. As the Centers for Disease Control and Prevention note, only certain treatments — sulfur ointment or permethrin — are appropriate for use in infants.

Other medications used to treat scabies include the oral medication Stromectol (ivermectin) or the topical lotions Eurax or Crotan (crotamiton).

Itch Relief

For relief from scabies itching, your dermatologist may suggest:

  • Taking an oatmeal bath
  • Taking a cool bath
  • Applying a wet, cool washcloth to the affected areas
  • Applying over-the-counter calamine lotion or topical steroids
  • Taking antihistamines.

Treatment for Family Members

The doctor will more than likely ask family members and those who’ve been in close contact with the infected person to go through an exam and scabies treatment because the mites spread so easily. This medical advice is invaluable because it will also help avoid a reinfestation.

Find Your Team

MyEczemaTeam is the social network for people with eczema and their loved ones. More than 37,000 members come together to share support, advice, and stories from their daily lives with others who understand life with eczema.

Have something to add to the conversation? Share your thoughts in the comments below or by posting on MyEczemaTeam.

Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
J. Christy McKibben, LPN is a freelance writer and licensed practical nurse in North Carolina. Learn more about her here.

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