Skin parasites: how to spot, treat, and prevent them

Skin parasites can show up as itching, red bumps, or small tunnels under the skin. Common culprits include scabies mites, lice, fleas, ticks, and hookworm larvae that cause cutaneous larva migrans. Symptoms vary: intense night itching often points to scabies, while visible tiny moving bugs on the scalp suggest lice. Flea bites appear as clusters of small red spots, and a tick bite can leave a single sore that may need removal.

When you notice symptoms, act quickly. For scabies, doctors often prescribe 5% permethrin cream applied to the whole body from the neck down, usually overnight, and repeated after a week. Oral ivermectin is another option for larger outbreaks or when topical creams aren’t practical. For head lice, over-the-counter treatments with permethrin or dimethicone work well; combing wet hair with a fine-tooth nit comb helps remove eggs. Cutaneous larva migrans from walking barefoot on contaminated sand or soil is treated with oral albendazole or ivermectin, and the skin lesion usually heals after treatment.

Safe treatment tips

Follow the exact instructions on prescriptions and product labels. Don’t overuse topical steroids to control itching—these can thin skin and mask infection. When using oral drugs like ivermectin, disclose any liver problems, medications, or pregnancy to your clinician. Treat close contacts and clean bedding, clothing, and stuffed toys in hot water or seal items in plastic for several days to starve mites and lice. For ticks, remove the whole tick with forceps, pulling straight out without twisting, and clean the area. Save the tick if you need testing.

Prevention and when to see a doctor

Preventive steps matter: avoid prolonged skin contact with infested people, wear shoes on beaches and in areas with animal feces, and use insect repellent in tick zones. Check pets for fleas and treat them; animal parasites can spread to people. If you have a spreading rash, severe pain, fever, swollen glands, or signs that the infection is not improving after treatment, see a healthcare provider. Also seek help if the rash affects children, older adults, or anyone with a weak immune system.

Be cautious about sourcing medications online. Use verified pharmacies and watch for fake or low-quality products—incorrect dosing or counterfeit creams can make things worse. If you’re unsure about a product or diagnosis, take a photo of the rash and bring it to a clinic or telehealth visit. Quick identification and the right treatment usually clear most skin parasite problems within days to a few weeks.

Small community outbreaks need quick coordination: tell close contacts, clean shared furniture, and avoid group sports until treatment finishes. In tropical areas, sand and stray animals raise risk—rinse feet after beaches and don’t sit directly on warm sand without a towel. For persistent or unusual rashes, skin scraping or dermoscopy in clinic helps pin down the parasite. Lab tests can identify eggs, larvae, or mites so treatment targets the exact cause. Keep a treatment log and follow up if symptoms return promptly.