Medically reviewed by Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket. Last reviewed: September 2026.
Scabies is more common than people think among backpackers and long-stay travellers, often picked up in shared accommodation. The itch is intense, especially at night, and treatment works well, but only if close contacts are treated at the same time and bedding is washed.
Scabies is not a sign of poor hygiene, and it is not something you catch from a clean hotel pillow in a single night. The people who see us about it are often long-stay visitors, backpackers moving between shared rooms, couples where one partner started scratching first, or families whose child brought it from school at home. Many have already tried a pharmacy antihistamine or steroid cream, which calms the rash for a while but leaves the mites alive. The telling detail is almost always the same: an itch that becomes unbearable at night.
What scabies is and how it spreads
Scabies is an infestation of the skin by a tiny mite called Sarcoptes scabiei. The female burrows into the top layer of skin and lays eggs there, and the intense itch is an allergic reaction to the mites, their eggs and their waste. Mites pass between people mostly during long periods of close skin contact: sleeping in the same bed, cuddling a child, or sex. Brief contact like a handshake rarely passes it on, and spread through bedding, towels or clothes is less common, since mites survive only about 2-3 days away from the body.
Timing explains why holiday scabies surprises people. In a first infestation the itch starts 2-6 weeks after contact, because the immune system needs time to react, so scabies noticed in Phuket may well have been caught before you travelled. Someone who has had scabies before reacts within 1-4 days.
Recognising scabies and ruling out look-alikes
Look for small, itchy red bumps and, if you are lucky, burrows: thin, wavy grey or silvery lines a few millimetres long. Favourite places are the webs between the fingers, the wrists, elbows, armpits, waistline, buttocks, genitals and around the nipples. In babies, the palms, soles, scalp and face can be affected. Other people in your room itching too is a strong clue.
| Condition | Where it appears | Distinguishing clue |
|---|---|---|
| Scabies | Finger webs, wrists, waist, genitals | Worse at night, burrows, others in the household itchy |
| Bed bug bites | Skin exposed while sleeping | Lines of three or four bites, no burrows |
| Sand fly bites | Ankles and lower legs | Appeared after sitting on the beach |
| Eczema | Elbow and knee creases, hands | Dry, scaly patches, often a long history |
| Heat rash (miliaria) | Neck, chest, back, skin folds | Prickly pinpoint spots that fade in the cool |
Crusted (Norwegian) scabies
When immunity is low, for example in frail elderly people or those on immune-suppressing drugs, scabies can build thick, grey crusts packed with huge numbers of mites. Crusted scabies is highly contagious, may itch surprisingly little and needs combined treatment, often with specialist or hospital input.
How we diagnose and treat scabies
We examine the skin under good light and magnification for burrows in typical places, check for infected scratches and ask who else has been in close contact with you.
Permethrin 5% cream is the standard first-line treatment. Apply it to cool, dry skin over the entire body from the neck down, including between fingers and toes, under the nails, the soles and the genitals. Babies, older adults and people with weak immunity also need the scalp, face and ears treated, avoiding the eyes and mouth. Leave it on for 8-12 hours, overnight is easiest, then wash it off, and reapply to your hands if you wash them during that time. Repeat the whole application one week later, because eggs laid before the first treatment may hatch. Permethrin can be used in pregnancy, while breastfeeding and from two months of age.
Oral ivermectin, a tablet dosed by weight and repeated 7-14 days later, is an alternative when cream is impractical and a key part of treating crusted scabies; it is not used in pregnancy or in small children. Benzyl benzoate lotion and sulfur ointment are other options used in Thailand. For the itch we add antihistamines, moisturisers and, after the mites have been dealt with, sometimes a mild steroid cream, plus antibiotics if scratching has led to impetigo or another bacterial infection.
Cleaning your room and belongings
On the day of the first treatment, wash all clothes, towels and bedding used in the previous three days at 50°C or hotter, then tumble-dry hot. Anything unwashable, such as shoes or a soft toy, goes into a tied plastic bag for 72 hours, by which time any mites will be dead. Ask housekeeping for fresh linen and towels. There is no need to fumigate the room, and pets do not carry human scabies.
When to see a doctor
Any persistent night-time itch with a rash deserves an examination rather than guesswork, especially before buying creams for the whole family. Come back if itching lasts beyond four weeks after treatment or new burrows appear.
Prevention and early detection
Avoid prolonged skin contact and bed-sharing with anyone who has an unexplained itchy rash, and do not share towels or clothing in hostels or shared villas. Early detection is mostly about paying attention to other people: if your partner or child starts scratching at night, get examined together. Because first infestations stay silent for weeks, a new sexual partner may also need a sexual health check at the same visit.
Getting a scabies check with us
Scabies consultations are discreet and available day and night at our Kata-Karon clinic, Bangtao (Cherngtalay) clinic and Patong clinic. As a walk-in doctor in Phuket service, we see you without booking, and a doctor hotel visit in Phuket lets us examine the whole family in your room. Contact us on WhatsApp or call +66 81 718 9080, and we will confirm the cost on WhatsApp before you come. Ask us on WhatsApp whether the treatment you need is in stock today. We bill most travel insurers directly and supply receipts, a medical report and an itemised invoice.
Related services and treatments
If you were prescribed scabies cream at home and ran out before the second application, our prescription refill in Phuket service can help. Scratched scabies sores sometimes become infected and need skin infection treatment, while clusters of bites on the ankles are more likely to need insect bite treatment. Other skin problems we treat include burns needing sunburn treatment, stings needing jellyfish sting treatment and painful one-sided rashes needing shingles treatment. See all conditions we treat.
Summary
Scabies causes a relentless night-time itch and is cured with two applications of permethrin 5% one week apart, applied carefully from the neck down. Success depends on treating all close contacts at the same time and hot-washing bedding, towels and clothes. Expect some itch for a few weeks afterwards, and come back if new burrows appear.
“Treat everyone you share a bed or room with on the same day, and wash bedding and clothes on a hot cycle. Otherwise the mites simply return.”
Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket
Frequently asked questions
Will my insurance pay for scabies treatment in Phuket?
A skin condition that starts on your trip is often covered by travel insurance, including the consultation and medicines, but terms and excesses vary. We bill most travel insurers directly, and we provide receipts, a medical report and an itemised invoice if you claim yourself. Prices are agreed on WhatsApp in advance, including for family members.
Do I need an appointment, and can I be seen tonight?
No appointment is needed, and all three clinics are open 24 hours, so you can come in when the itch keeps you awake. Walk-in patients are usually seen within minutes, and most visits take under 30 minutes, including collecting treatment from our on-site pharmacy. Bring anyone you share a bed with if possible.
Can a doctor check my family for scabies at our hotel?
Yes. We can send a doctor to your hotel or villa anywhere on the island, day or night, to examine everyone in the room and explain how to apply the treatment and clean your belongings. This is often easier than bringing young children to a clinic and keeps the consultation private.
When am I no longer contagious after treatment?
After the first full application has been left on for the recommended 8-12 hours and washed off, you are generally no longer considered contagious, and many guidelines advise avoiding close contact for 24 hours after starting treatment. You can usually travel and fly, but the second application one week later is still essential.
Why am I still itching two weeks after using the cream?
Post-scabies itch is common and can last 2-4 weeks, because the skin keeps reacting to dead mites and their debris. Moisturisers, an antihistamine at night and sometimes a mild steroid cream help. It is not a reason to keep reapplying permethrin, but new burrows or a spreading rash after four weeks need a review.
Does my partner need treatment if they are not itchy?
Yes. Close contacts can carry mites for weeks before any itch starts, so partners, children and anyone sharing your bed need treating on the day you start, whether or not they itch. If they are not treated, they can pass the mites back to you once your own treatment has finished.
Sources
The NHS explains how to apply scabies treatment correctly. The World Health Organization fact sheet on scabies worldwide covers transmission and crusted scabies, and MedlinePlus has a plain-language scabies overview.
Scabies, Sarcoptes scabiei, burrows, crusted scabies, Norwegian scabies, post-scabies itch, secondary bacterial infection, permethrin 5% cream, ivermectin, benzyl benzoate, sulfur ointment, bed bugs, eczema, NHS, WHO, MedlinePlus, Takecare Clinic Phuket, Kata, Karon, Bangtao, Patong, Dr. Ponlawat Pitsuwan
This page is general health information and not a substitute for a medical consultation.