Scabies Treatment in Phuket: Diagnosis, Permethrin and Ivermectin

Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket. Last reviewed: September 2026.

“We usually meet scabies a few weeks into a long trip. Backpackers who have moved between hostels, couples who have been travelling together, and long-stay visitors often come in convinced they have bed bugs or sandfly bites that will not stop itching. The clue is the night-time itch and the places it affects: finger webs, wrists, the waistband and the genitals. Treatment is simple, but it only works if everyone who shares your bed is treated on the same day.” Dr. Ponlawat Pitsuwan

What is scabies?

Scabies is a skin infestation by a tiny mite, Sarcoptes scabiei, which is too small to see clearly without magnification. The female mite burrows into the top layer of the skin and lays eggs as she goes. The intense itch is not caused by the mite biting; it is an allergic reaction by your immune system to the mites, their eggs and their droppings.

Scabies spreads mainly through prolonged skin-to-skin contact, for example sharing a bed, sexual contact, or close contact within a family. A quick handshake or hug is unlikely to pass it on. It can occasionally spread through shared bedding, towels and clothing, because mites can survive off the body for up to about three days. Scabies has nothing to do with poor hygiene; anyone can get it, and hostels, dormitories and shared accommodation make it easier to pass around.

A rare severe form, crusted scabies (previously called Norwegian scabies), occurs in older people and those with a weakened immune system. It causes thick, grey, crusted skin containing very large numbers of mites, is highly contagious, and needs combined treatment under close medical supervision.

Scabies symptoms, and what else it can look like

The hallmark is intense itching that is worse at night or after a hot shower. The rash appears as small red bumps and sometimes tiny blisters, and you may see burrows: thin, wavy, greyish or silvery lines a few millimetres long. Common sites are the webs between the fingers, the sides of the fingers, the wrists, elbows, armpits, around the nipples, the waist and belt line, the buttocks and the genitals. In adults the face and scalp are usually spared, but in babies and young children the head, palms and soles can be affected.

If you have never had scabies before, symptoms usually appear two to six weeks after you are infested, as your immune system becomes sensitised. That delay is why you may have caught it earlier in your trip, and why people close to you can be infested without any symptoms yet. If you have had scabies before, symptoms can appear within one to four days of reinfestation.

How we diagnose and treat scabies at Takecare

Diagnosis is usually made by examination. The doctor looks for burrows and the typical distribution of the rash, often with a dermatoscope, a handheld magnifier with a light, which can show the mite at the end of a burrow as a small dark triangle. We ask who you have been sharing a bed or close contact with and whether they are itchy too. Occasionally we take a gentle skin scraping to look for mites or eggs under a microscope.

First-line treatment in most guidelines is a topical treatment, permethrin 5% cream. It is applied to cool, dry skin over the whole body from the neck down, including between the fingers and toes, under the nails, around the genitals and the soles of the feet. In young children, older adults and people with a weakened immune system the scalp, face and ears are included too, avoiding the eyes and mouth. The cream is left on for 8 to 12 hours, usually overnight, then washed off, and reapplied if you wash your hands during that time. The whole treatment is repeated after 7 days to kill any mites that hatch from eggs.

Oral ivermectin is an effective alternative, taken as a weight-based dose (200 micrograms per kilogram) and repeated after 7 to 14 days. It is useful when creams are impractical, for widespread or crusted scabies, or for outbreaks in groups. It is not generally used in pregnancy or for children weighing under 15 kilograms, where permethrin is preferred. Infants under 2 months need specialist advice before any scabies treatment. If scratching has broken the skin and it has become crusted, weeping or painful, a secondary infection with bacteria is likely, and the doctor treats that with an antibiotic alongside the scabies treatment. We explain exactly how to apply or take your treatment and supply it from our on-site pharmacy.

All household members, sexual partners and anyone who has shared your bed in the past six to eight weeks should be treated on the same day, even if they have no symptoms. Clothes and bedding, and towels, used in the three days before treatment should be washed at 60°C and dried on a hot cycle. Items that cannot be washed can be sealed in a plastic bag for at least 72 hours. If you are staying in a hotel, let housekeeping know that you need fresh linen after each treatment.

The itch usually continues for two to four weeks after successful treatment while the skin reaction settles, even though the mites are dead. We treat this with an oral antihistamine at night, a moisturiser and sometimes a mild steroid cream once the course is complete. Scratched skin can become infected with bacteria, causing impetigo, which we treat at the same time.

When to see a doctor

See a doctor if you have an itchy rash that is worse at night and has lasted more than a few days, especially if a partner or travel companion is itchy too. Scabies needs a prescription-strength treatment and a proper diagnosis, because many look-alike rashes need completely different treatment. See a doctor promptly for a baby or young child with a widespread itchy rash, during pregnancy or breastfeeding, and for anyone older or with a weakened immune system who has thick, crusted skin.

Come back if the itch is still present more than four weeks after the second treatment, if new burrows or new spots appear after treatment, or if the skin becomes painful, weepy, crusted or swollen, which suggests a bacterial infection. Scabies itself is not an emergency. However, if infected skin is spreading rapidly and you develop a high fever, confusion or feel faint, go to a hospital emergency department or call 1669.

Prevention and early detection

There is no vaccine for scabies, so prevention is about contact. If you have been diagnosed, avoid close skin contact and sexual contact until you and your partners have completed the first treatment. Do not share towels, clothing or beds in hostels or shared accommodation, and use your own sleeping sheet if you are staying in dormitories. Because symptoms take weeks to appear the first time, tell recent partners so they can be treated even if they feel well.

Early detection matters because every week of untreated scabies gives the mites more chance to spread to the people around you. An itchy rash that keeps you awake at night deserves a doctor’s look rather than another tube of anti-itch cream. After treatment, check for new burrows at two and four weeks.

Visiting Takecare Clinic in Phuket

You can walk in at any time of day or night, with no appointment, at Takecare Clinic Bangtao (Cherngtalay) on Bandon Road, Takecare Clinic Kata-Karon on Kedkwan Road, or Takecare Clinic Patong on Prachanukroh Road. Most visits take under 30 minutes, and treatment for you and your contacts can be dispensed from our pharmacy on the same visit.

If several people in a family or group are affected, a doctor can visit your hotel or villa anywhere in Phuket to examine and treat everyone together. Message us on WhatsApp or call 081-718-9080 to arrange it. Your consultation is private, and we are used to discussing scabies without embarrassment.

We confirm the price on WhatsApp before your visit, offer direct billing with most travel insurers, and provide a medical report and itemised receipt for your claim.

Related services and treatments

Scabies is often mistaken for bites, so if your itchy spots are on the ankles and appeared after an evening on the beach, our page on insect bite treatment may be more relevant. If you are on long-term medicines for another condition and are running low, we can also arrange a prescription refill in Phuket at the same visit. For a quick check of any rash, a walk-in doctor in Phuket is available at all three branches.

Other skin problems we treat for travellers include peeling, blistered skin that needs sunburn treatment, welts from the sea that need jellyfish sting treatment, and a painful band of blisters on one side of the body that needs shingles treatment. If you cannot leave your room, request a doctor hotel visit in Phuket.

Summary

Scabies is a mite infestation that causes an intensely itchy rash, worst at night, in the finger webs, wrists, waist and genitals. It spreads through prolonged skin contact and shared beds, which is why it is common among travelling couples and in hostels. Permethrin 5% cream applied from the neck down twice, one week apart, or ivermectin tablets, cures it when all close contacts are treated at the same time and bedding is washed at 60°C. The itch can last two to four weeks after cure. Takecare Clinic Phuket diagnoses and treats scabies 24/7 at our three branches or at your hotel.

“Put a reminder in your phone for day seven before you leave the clinic. The second application is the one people forget, and it is the one that catches the mites that hatched after the first.” Dr. Ponlawat Pitsuwan

Frequently asked questions

How did I catch scabies?

Scabies spreads mainly through prolonged skin-to-skin contact, such as sharing a bed with a partner, sexual contact or close family contact, and less often through shared bedding, towels or clothing. Because symptoms can take two to six weeks to appear the first time, you may have caught it earlier in your trip. It has nothing to do with how clean you are.

How long does scabies itching last after treatment?

The itch commonly continues for two to four weeks after successful treatment, because the skin is still reacting to dead mites and their debris. This does not mean the treatment has failed. Antihistamines at night, moisturisers and sometimes a mild steroid cream help. See a doctor if the itch lasts beyond four weeks or new burrows or spots appear.

Does my partner need scabies treatment if they have no symptoms?

Yes. Anyone who has shared your bed or had close skin contact with you in the past six to eight weeks should be treated on the same day as you, even without symptoms, because they may already be infested but not yet itchy. Treating only the person with symptoms is the most common reason scabies comes back.

Can I get scabies treatment in Phuket without an appointment?

Yes. All three Takecare branches in Bangtao, Kata and Patong accept walk-ins 24 hours a day, and you are usually seen within minutes by an English-speaking doctor. The diagnosis is made by examination, and permethrin cream or ivermectin tablets for you and your contacts can be supplied from our pharmacy before you leave.

Can a doctor treat scabies at my hotel?

Yes. Our doctors visit hotels and villas anywhere in Phuket, day or night. This is convenient when a whole family or group needs to be examined and treated together, and the doctor can explain the application routine and bedding advice in person. Let us know on WhatsApp how many people need to be seen.

Does travel insurance cover scabies treatment?

Many travel insurance policies cover consultations and medicines for skin conditions that start during your trip, but cover varies, so check your policy wording. We offer direct billing with most travel insurers, and if you pay first we provide a medical report and itemised receipt for your claim. Send us your insurer’s name on WhatsApp and we will confirm before you visit.

Sources

NHS: Scabies. WHO: Scabies fact sheet. CDC: About scabies.

Scabies, Sarcoptes scabiei, scabies mite, burrows, crusted scabies, Norwegian scabies, pruritus, night-time itch, dermatoscopy, skin scraping, permethrin 5% cream, ivermectin, antihistamine, impetigo, close contacts, bedding at 60°C, bed bugs, eczema, contact dermatitis, tinea, NHS, WHO, CDC, 1669, Bangtao, Cherngtalay, Kata, Karon, Patong, Phuket, Dr. Ponlawat Pitsuwan, Takecare Clinic Phuket.

This page is general health information and not a substitute for a medical consultation.