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Scabies and eczema are skin rashes of biblical proportions. You won’t find them in the 10 Egyptian plagues, but they share a hauntingly familiar look: red, scaly, and filled with pus. Both itch like wolves howling at the moon.

However, their origin stories and treatments are like night and day. Scabies are highly contagious through skin-to-skin contact, while eczema just isn’t. In fact, eczema is an autoimmune disorder akin to hay fever or asthma.

Although both are bothersome, scabies can be treated and vanquished, while eczema is a lifelong companion.

The sarcoptes scabiei is an eight-legged microscopic mite that causes scabies.

These unseeable mites crawl under the top layer of your skin, and the females (yes, they’re gendered) lay eggs, which produce larvae, which grow into mites, which burrow under your skin and lay more eggs.

In other words, these tiny vampires feed off your body from the inside in an endless cycle of itchiness.

“Eczema” is a general term for atopic dermatitis, a chronic skin condition with no known cause. Researchers believe that people develop it through a combination of triggers and inherited factors. Thanks, Grandpa.

Defining characteristics:

ScabiesEczema
Rashes of red, pimple-like bumps or blistersRed, inflamed skin
Scaly skinRough, leathery, or scaly patches of skin
Small, raised, crooked lines on your skinOozing or crusting
Sores caused by scratchingDark-colored areas of skin
Itching that worsens at nightIntense itch

Anyone can get scabies. The mites don’t care about your economic status, race, or personal hygiene — they love everyone’s skin.

Most people get scabies from prolonged skin-to-skin contact, such as by holding hands (so sweet), having sex (so hot), or sharing clothing, bedding, or towels with someone who has scabies (so ewww).

It’s possible to spread scabies before you even know you have it, because scabies can take root in your skin 3 to 6 weeks before the telltale rash appears.

One possible way to avoid scabies is to never have prolonged contact with another human, ever. OK, maybe that’s a tiny bit extreme.

FYI

To be clear, you can’t get scabies from quick physical contact like handshakes or hugs or from sitting on the toilet. But you could get them by sitting on an infested surface, like furniture or a gym bench.

And once you have scabies, they can be difficult to shake — these tenacious mites can live on your skin for up to 2 months.

The good news is they don’t set up shop on a person’s scalp or face. And once they’re off the human body, they typically die within 3 to 4 days.

The word “eczema” is derived from the Greek word “ekzema,” meaning “to boil over,” which is a good description for the red, inflamed, itchy patches that occur during flare-ups.

More than 30 million Americans have eczema, which usually starts in infancy or childhood but can also begin during the teen years or even in adulthood (oh, joy).

Management is key to handling this condition. Peeps with eczema tend to have an overactive immune system that responds to irritation with inflammation. That inflammation causes red, itchy, and painful skin.

Eczema ranges from mild to severe and often appears as unusually dry skin that must be tended to keep its protective barrier healthy. This translates into a regular routine of gentle cleansing followed by a moisturizer to lock water into the skin.

Most people develop a personalized regimen through trial and error. Some find that sticking to a specific diet can help prevent flare-ups.

Some conditions look so similar that they aren’t easily distinguished, which can delay diagnosis and treatment. That’s the case with eczema and scabies. But a healthcare provider should be able to diagnose them.

Unfortunately, there’s no definitive test for eczema. The only way a doctor can diagnose it is by inspecting your skin and reviewing your family medical history.

Scabies, on the other hand, is more obvious. A healthcare provider could inspect the affected area, see the raised burrows, and — voila! — arrive at a diagnosis.

Or they might remove a mite from your skin with a needle or scrape off a small section of your skin and study the tissue under a microscope to confirm it’s scabies.

The treatments for eczema and scabies are worlds apart. Since scabies spreads so easily, the primary patient and anyone who’s been hanging out with them should immediately seek medical treatment.

In the case of eczema, the patient will gradually develop a regular regime to keep their skin condition in check.

Scabicide

It takes determination to get rid of scabies. But you can do it! Your doctor will prescribe a “scabicide” that comes in the form of a lotion or spray and kills both scabies mites and eggs.

Currently, no over-the-counter (OTC) products are approved by the FDA to treat scabies. Don’t even think about hitting up the pharmacist without a prescription. Just go to the doctor.

The CDC advises the use of Permethrin to take out scabies. Permethrin is a synthetic pyrethroid, a medicine similar to those found naturally in the chrysanthemum flower.

It’s considered safe enough to use on children 2 months or older. Two (or more) applications, about a week apart, should eliminate all the mites.

For the best results, you should rub Permethrin over your entire body, from your neck down to the soles of your feet, and leave it on for the amount of time listed on the package or recommended by your doctor.

After showering it off, it’s a good idea to put on freshly washed clothing.

In addition, ALL your bedding and towels and all clothing you wore while you had scabies must be washed and dried on the hottest possible setting. Toast those micro-monsters at 122°F (50°C) for 20 minutes and they’re finished.

Items that can’t be machine washed should be placed in a sealed bag and stored for at least 4 days. Scabies mites need a human to thrive — without one, they die after 3 days.

And just to be on the safe side, vacuum any carpets or furniture that anyone with scabies might have spent time on, and toss out the vacuum bag. It’s not necessary to call an exterminator or have your home fumigated.

After all this effort, the itching may continue for a couple of weeks after treatment, even if all the mites and eggs have been killed. But if you’re itching for more than 2 weeks, or if new burrows or pimple-like rashes appear, you may need more treatment.

Just keep swimming

Eczema treatment can involve OTC creams, prescription steroid creams, phototherapy, immunosuppressants, biologic drugs, or a combination of these methods. Some people also find relief from certain natural and alternative treatments.

For most types of eczema, a daily bathing and moisturizing routine is necessary. Consistent use of non-perfumed OTC creams and prescription medication (if needed) can help stave off flare-ups.

People who have eczema also need to stay on top of potential triggers — like seasonal changes, allergens, or stress — to keep their skin from blowing up.

Eczema and scabies may look like twins, but they’re not. Scabies demands immediate medical attention, while eczema acts like a demanding life partner.

If you develop an itchy rash, there’s no shame in calling your doctor and asking to be seen right away. Scabies can only be cured through medical intervention. If it’s eczema, your doctor can help you find a treatment that works for you.

So, wanna snuggle?