If you regularly find yourself scratching at red, scaly patches of skin on your body, you may be one of the nearly 32 million Americans who suffer from eczema, a chronic inflammatory skin condition that dermatologists refer to as atopic dermatitis. But if you’re not prone to dryness and irritation, and that itchy area just showed up out of the blue or perhaps after a recent trip, you might be dealing with scabies instead.
“Scabies are red, itchy patches caused by tiny mites, or bugs in the arthropod family,” says Danilo C. Del Campo, M.D., a board-certified dermatologist in Chicago, and a fellow of the American Academy of Dermatology. “They burrow just underneath the surface of the skin, our immune system reacts to their waste, and we start to itch.” Red, scaly patches form next, which can look and feel very similar to eczema—but there are noticeable differences.
Is It Eczema or Scabies?
While the two conditions initially look similar, there are a combination of factors that health care providers look for when they determine if red, irritated skin is eczema or scabies, says Dr. Del Campo. “With scabies, it’s the onset, distribution, and pattern of the rash that we look for,” he says.
Scabies is an extremely itchy rash with small, pimple-like bumps, and sometimes it’s possible to see the burrow lines or tracks created by the mites when the condition is more advanced, says Dr. Del Campo. On the other hand, eczema can feel mildly to moderately itchy, and it looks like patchy, red areas with flat blisters filled with clear liquid that can break open.
Eczema is not contagious, which means you can’t catch it from someone else. But the mites that cause scabies are highly transmissible—they travel from one person, or host, to another very easily. “Scabies spreads through close skin-to-skin contact and occasionally through shared clothing or bedding,” says Peter Lio, M.D., a board member of the National Eczema Association, board-certified dermatologist, and clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago. “It is fortunately not very common, but can appear in clusters especially in hospitals, nursing homes, and schools.”
The location of the rash can also provide a clue for identifying scabies or eczema. Scabies tends to appear on the wrists and hands, especially in between the fingers, or on the torso, along the waistline and near the belly button. Meanwhile, eczema can appear anywhere and tends to recur in the same places when it becomes chronic—often leading to areas of darker, thickened skin.
Both scabies and eczema can be itchy, but scabies tends to be more intense—especially at night. “Many of my patients notice those irritated, highly itchy areas more when the distractions of the day are gone,” says Erika Luren, N.P., a dermatology nurse practitioner in Las Vegas, NV, and the author of Malcolm Finney, Medical Detective: The Case of Itch and Rash, a children’s book about eczema. It’s important to avoid scratching as best as you can, she says, since it can lead to open sores and infection.
Treatment of Scabies vs. Eczema
Eczema is a chronic condition, meaning you can’t cure it—but you can manage it. The skin dryness and irritation that comes with eczema can temporarily be soothed with over-the-counter lotions and creams. Dr. Del Campo recommends finding one at the drugstore that’s fragrance-free and contains ceramide, an emollient ingredient that helps to repair and maintain skin barrier function. “They usually come in a jar or tub and are formulated for sensitive skin,” he says. More severe cases of eczema may warrant prescription topical or systemic medications.
Making tweaks to your diet may also ease eczema. Nutrition research shows eating more fatty fish, like salmon and sardines, probiotic-rich foods, like yogurt and fermented pickles, and fruits and veggies high in quercetin, like apples and broccoli, may lead to a reduction in overall inflammation, which can help reduce the severity and frequency of eczema flare ups. Avoiding foods that commonly trigger inflammation, such as dairy, peanuts, eggs, and wheat, has also been shown to keep skin clear.
Unlike eczema, scabies can’t be managed by eating better or moisturizing more often—you need a prescription. On the other hand, “for scabies, treatment is usually a lot more straightforward and tends to be something we can cure, rather than just treat,” says Dr. Lio.
If you have scabies, your health care provider can prescribe an anti-scabies medication. “We usually use a topical cream called permethrin applied head to toe and then washed off the next day, and then repeated in one week,” says Dr. Lio. That will eliminate the mites and help to clear up the rash and irritation. You’ll want to follow the treatment instructions carefully to prevent reinfestation and to ensure you don’t spread scabies to others.
“Taking an oral antihistamine may also ease the itching from scabies, especially at bedtime,” says Luren.
Other Rashes That Can Be Mistaken for Scabies
Scabies, eczema, stress rash—it’s common to misidentify a skin issue. A patchy, inflamed area can be caused by any number of environmental irritants, or it could be linked to a genetic factor, so what you think might be scabies or eczema could be a whole other type of rash. Here are some other skin concerns that can be mistaken for scabies:
Bug bites. These are single, raised bumps or a series of bumps caused by a reaction to a bite from an insect, such as a mosquito, tick, or spider. Seek medical attention if other symptoms, like fever or fatigue, are present.
Contact dermatitis. This condition involves redness, burning, itching, or inflammation that occurs when your skin comes into contact with a physical or chemical irritant or an allergen.
Heat rash. This consists of raised, red bumps known as miliaria, which are caused by sweat trapped beneath the skin and are most common during hot, humid weather.
Hives. These are red, swollen, and itchy welts that suddenly appear on the skin and are typically caused by an allergic reaction to food, a bug bite, a change in temperature, or other stimuli.
When to See a Doctor for Scabies or Eczema
It’s difficult to self-diagnose eczema and it can be even trickier to identify scabies, because the conditions can look and feel so similar. If over-the-counter moisturizers aren’t helping to ease the itchiness, dryness, or inflammation, a visit to your primary care provider or a dermatologist is a good idea. It’s also smart to seek medical care if there are signs of skin infection, like pain, pus, red streaks, and odor, or if the urge to scratch lasts longer than four weeks, says Luren.
“In the office there are certain tests we can run to determine if it’s eczema or scabies,” says Dr. Del Campo. “We can do a skin scraping and analyze it under a microscope, where we can see the mites or eggs, which makes it easy to diagnose scabies.”
Luckily, scabies hasn’t been linked to any long-term health issues. “It’s definitely a nuisance,” says Dr. Del Campo, “but scabies isn’t connected to the transmission of other more serious infections.”
“Generally, we can eradicate scabies and get patients back to 100% normal, though it can be a few rough months of residual post-scabies itch sometimes,” adds Dr. Lio.
Still, experts recommend seeing a dermatologist any time you’re experiencing significant skin redness, scaling, itchiness, or irritation. “People are often concerned that they have bedbugs or something worse,” says Dr. Del Campo, “but a dermatologist can quickly diagnose eczema or scabies by recognizing the onset, pattern, and distribution of the rash, and then determine the best treatment options for you.”
