Eczema and scabies can have similar signs and symptoms, such as intense itching, scaly patches, and dry, discolored skin. However, despite these similarities, their causes and treatments are very different. Scabies spreads easily from person to person, but eczema is not contagious. Additionally, scabies can be cured with proper treatment, whereas eczema is a chronic condition that can be managed but not cured.

According to the National Eczema Association, more than 31.6 million Americans (about 10 percent of the population) are living with some form of eczema. The World Health Organization (WHO) reports that worldwide, scabies affects more than 200 million people (about 2.4 percent) at any given time.

In this article, we’ll explore five differences between eczema and scabies, including their symptoms, causes, and treatment options. We’ll also show eczema versus scabies lesions to help you tell the difference between these conditions. If you’re experiencing symptoms of either condition, it’s important to consult a health care provider who specializes in dermatology. A specialist can accurately diagnose your symptoms and help you find the most effective treatment options.

1. Scabies Is Contagious, but Eczema Isn’t

Eczema is a chronic (long-term) inflammatory skin condition, with atopic dermatitis being the most common type. It’s characterized by dry, intensely itchy skin that may appear discolored. Depending on a person’s skin tone, affected areas can look red, purple, gray, brown, or ashen. Eczema isn’t contagious, and there is no cure. People with eczema often experience periodic flare-ups, during which symptoms worsen or reappear. For some individuals, these flare-ups are associated with seasonal allergies or asthma.

Scabies, on the other hand, is a highly contagious skin condition caused by skin mites. These mites burrow into the skin, causing intense itching and characteristic rashes. Infected individuals may develop thin, irregular tracks, along with small, itchy pimples or blisters. In severe cases, scales or crust may form on the skin.

2. Eczema Is Caused by the Immune System While Scabies Is Caused by Mites

One of the main 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 mutation (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 developing eczema themselves. Food allergies may also trigger eczema flare-ups.

Although eczema can develop at any age, young children are at a greater risk of developing the condition.

Scabies Causes and Risk Factors

Scabies is caused by the Sarcoptes scabiei mite, which burrows into the top layer of a person’s skin to feed and lay eggs. The mites, also called human itch mites, are too small to be seen with the naked eye.

A more severe form of scabies is known as crusted scabies (also called Norwegian scabies). A person with typical scabies may have around 15 to 20 mites burrowed into their skin. In contrast, someone with crusted scabies may have hundreds to thousands of mites. Crusted scabies usually occurs in individuals with weakened immune systems or underlying health conditions, allowing the mites to multiply more rapidly.

Scabies is primarily spread through close physical contact. Transmission can also occur through contact with infected bedding or clothing. The mites can spread quickly in crowded environments such as nursing homes, childcare centers, dormitories, prisons, or family households.

Anyone can develop scabies, but it is more common in people living in overcrowded or unsanitary conditions. Young children, elderly individuals, and those with compromised immune systems are also at higher risk.

3. Eczema and Scabies Have Different Skin Symptoms

Although eczema and scabies have very different underlying causes, it can sometimes be difficult to tell their rashes apart. Both conditions share many signs and symptoms.

One of the most notable similarities is that both cause severe itching in most people. This intense itching is often worse at night and can lead to significant discomfort and sleep loss. Both conditions can also cause rashes with small, raised bumps or blisters. A form of eczema that may closely resemble scabies is dyshidrotic eczema, which usually appears as small blisters on the hands and feet.

Severe itching often leads to scratching, which can cause the bumps or pustules to break open and leak fluid. This can result in crusting and increases the risk of infections. If left untreated, infections can become serious, particularly if bacteria enter the bloodstream.

Despite these similarities, there are important differences in how scabies and eczema appear on the skin.

Symptoms of Eczema

The signs and symptoms of eczema can vary widely. Affected skin may become extremely dry, cracked, raw, and swollen. Patches may range in color from red to brownish-gray. Over time, frequent scratching can cause the skin to thicken, making it appear leathery and darker in color.

Eczema can occur almost anywhere on the body, but it most commonly develops on or around the:

• Neck
• Inner elbows
• Hands
• Knees
• Ankles
• Feet
• Eyes

Symptoms of Scabies

The scabies rash and blisters often appear as narrow, irregular tracks on the skin. Scabies blisters may resemble hives, knots, or tiny bites beneath the skin. In more severe cases, such as crusted scabies, widespread crusts may develop in areas where many mites have burrowed into the skin.

People with scabies may not show symptoms for up to six weeks, but they can still spread the mites to others during this time.

Scabies tends to occur in the folds of the skin. The most common areas where 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

In young children and infants, scabies often appears on the soles of the feet, scalp, or palms of the hands.

4. Eczema Can Be Diagnosed Clinically, While Scabies Requires Microscopic Examination

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

Diagnosis of Eczema

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 cause similar symptoms. Conditions that may be confused with eczema include:

• Psoriasis
• Food allergies
• Bacterial, fungal, or viral infections

Testing for other conditions may involve a skin biopsy (removing a small sample of skin tissue for microscopic examination), allergy tests, blood tests, or patch tests.

Diagnosis of Scabies

Scabies is often diagnosed when the doctor identifies a characteristic burrow on the skin. If the diagnosis is unclear, the doctor may scrape the affected area to search for mites, eggs, or scybala (fecal matter). The scraping is then examined under a microscope to confirm the presence of mites and diagnose the infestation. Since scabies spreads easily through close contact, the doctor will likely ask if other household members or close contacts are also experiencing an itchy rash.

5. Eczema and Scabies Are Treated With Different Medications

Because eczema is a chronic inflammatory condition, while scabies is caused by a mite infestation, they require different treatment approaches.

Eczema Treatments

Many treatments and therapies are available to help manage symptoms of eczema. Regular moisturizing may be sufficient for some people, but medications are often needed. Common prescriptions include corticosteroids and antibiotics for any infections that may occur. Eczema is typically managed with topical medication. In severe or widespread cases, doctors may prescribe systemic treatments such as oral corticosteroids, immunosuppressants, or biologics.

A newer class of medications, called Janus kinase (JAK) inhibitors, can block certain signals in the body that trigger inflammation and may be prescribed for severe eczema.

It’s also recommended that people avoid triggers, such as certain soaps and lotions containing 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 with eczema 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 typically begins with scabicides, which are medications specifically designed to kill the mites causing the condition. It’s also important that anyone who’s been in close contact with the infected person receives treatment to prevent reinfestation. Doctors often recommend treating entire families or close groups when someone is diagnosed due to the high risk of transmission through skin-to-skin contact.

Scabicides

Scabicide medications, which must be prescribed by a doctor or dermatologist, are used to eliminate scabies mites. A scabicide prescription may require an individual to leave lotions or creams on for several hours. In some cases, multiple applications may be necessary. As noted by the Centers for Disease Control and Prevention (CDC), only certain treatments — sulfur ointment or permethrin — are considered safe for use in infants.

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

Itch Relief

For relief from scabies-related itching, your dermatologist may suggest:

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

Treatment for Family Members

Doctors will likely recommend that family members and anyone in close contact with the infected person undergo an exam and receive treatment. This is crucial because scabies mites spread easily, and treating close contacts helps prevent reinfestation.

Talk to Your Doctor

While eczema and scabies can share similar symptoms — such as intense itching, skin discoloration, and irritation — they are entirely different conditions with distinct causes and treatments. Having one doesn’t increase your risk for the other. However, if you’re living with eczema and notice new or worsening symptoms — whether they resemble scabies or something else — it’s important to consult a doctor. Changes in your condition could signal an infection or another underlying issue that requires medical attention.

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