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The rash and itching of scabies can persist for several weeks to a month after treatment, even if the treatment was successful and all the mites and eggs have been killed. Your health care provider may prescribe additional medication to relieve itching if it is severe. Symptoms that persist for longer than 2 weeks after treatment can be due to a number of reasons, including:

  • Incorrect diagnosis of scabies. Many drug reactions can mimic the symptoms of scabies and cause a skin rash and itching; the diagnosis of scabies should be confirmed by a skin scraping that includes observing the mite, eggs, or mite feces (scybala) under a microscope. If you are sleeping in the same bed with your spouse and have not become reinfested, and you have not retreated yourself for at least 30 days, then it is unlikely that your spouse has scabies.
  • Reinfestation with scabies from a family member or other infested person if all patients and their contacts are not treated at the same time; infested persons and their contacts must be treated at the same time to prevent reinfestation.
  • Treatment failure caused by resistance to medication, by faulty application of topical scabicides, or by failure to do a second application when necessary; no new burrows should appear 24-48 hours after effective treatment.
  • Treatment failure of crusted scabies because of poor penetration of scabicide into thick scaly skin containing large numbers of scabies mites; repeated treatment with a combination of both topical and oral medication may be necessary to treat crusted scabies successfully.
  • Reinfestation from items (fomites) such as clothing, bedding, or towels that were not appropriately washed or dry-cleaned (this is mainly of concern for items used by persons with crusted scabies); potentially contaminated items (fomites) should be machine washed in hot water and dried using the hot temperature cycle, dry-cleaned, or removed from skin contact for at least 72 hours.
  • An allergic skin rash (dermatitis); or
  • Exposure to household mites that cause symptoms to persist because of cross-reactivity between mite antigens.

If itching continues more than 2-4 weeks or if new burrows or rash continue to appear, seek the advice of a physician; retreatment with the same or a different scabicide may be necessary.

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