Pediatric Parasitic Skin Infections

What are parasitic skin infections?

Skin parasites are small insects or worms that burrow into the skin to live there or lay their eggs.

There are many types of parasitic skin infections that require clinical care by a physician or other healthcare professional. They include:

  • Scabies
  • Lice
  • Scabies

    What is scabies?

    Scabies is an infestation of mites (tiny insects) characterized by small red bumps and intense itching. This highly contagious infection often spreads from person to person while they are sleeping together in the same bed or have close personal contact.

    The itching is caused by the mites burrowing into the skin where they lay eggs that hatch a few days later. Scabies can affect people of all ages. Scabies occurs mostly in children and young adults.

    What are the symptoms of scabies?

    It may take between 4 to 6 weeks for a child to develop symptoms of scabies after coming in contact with an infected person.

    In children younger than 2 years of age, the lesions caused by the mites tend to occur on the head, neck, palms, and soles. In older children, the lesions are usually between the fingers, on the hands or wrists, along the belt line, on the thighs or belly button, in the groin area, around the breasts, and in the armpits.

    The following are the most common symptoms of scabies. However, each child may experience symptoms differently. Symptoms may include:

    • Itching, usually severe
    • Rash, with small pimples or red bumps
    • Scaly or crusty skin (with advanced conditions)

    How is scabies diagnosed?

    In diagnosing scabies, the skin and skin crevices are examined by a physician. A sample of skin, obtained by scraping the skin, may be examined under a microscope to confirm the presence of mites.

    What is the treatment for scabies?

    Scabies is treatable and usually all members in a family are treated at the same time. Specific treatment will be determined based on:

    • The child's age, overall health, and medical history
    • Extent of the infestation
    • The child's tolerance for specific medications, procedures, or therapies
    • Expectations for the course of the infestation
    • Child or parent’s opinion or preference

    Treatment may include:

    • Applications of prescription creams and lotions, such as permethrin and lindane solutions
    • Oral antihistamine medication (to help relieve itching)
    • In some cases, topical ointments are recommended

    In addition, it is important to wash all clothes and bedding in hot water and dry in a hot dryer in order to kill the mites. Clothing and other objects that cannot be washed (i.e., pillows, stuffed animals) should be placed in a plastic bag for at least one week.

    Also, the itching may continue for many weeks after the initial treatment of the scabies.


    What are lice?

    Lice are tiny insects that can infest the skin anywhere on the body. Lice infection is characterized by intense itching.

    Lice are highly contagious, spreading from person to person by close body contact, shared clothes, and other items (such as hats, hairbrushes, and combs). There are three types of human lice:

    Head lice

      • Head lice are seen mostly in child care settings and among school-aged children
      • The child usually has itching in the head area
      • Lice, or the eggs (called nits), can usually be seen on the hair, behind the ears, and on the neck

    Body lice

      • Body lice are usually seen in people with poor hygiene
      • Body lice are rare in children
      • Body lice cause severe itching, which is often worse at night
      • In some cases, lice and eggs can be found in the seams of clothes

    Pubic lice

      • Pubic lice are very contagious and can be transmitted through sexual contact or by contaminated items such as towels and clothes
      • Pubic lice can affect the pubic hair, but also can cause infections of the hair on the chest, abdomen, thighs, and eyebrows
      • Itching of the affected area is a common symptom of pubic lice

    How are lice diagnosed?

    The eggs laid by lice are usually visible to the naked eye, making it easy for a child's physician to diagnose. Pubic lice leave small brown spots on the parts of clothing that come into contact with the genitals or anus.

    What is the treatment for lice?

    The specific treatment for lice will be determined based on:

    • The child's age, overall health, and medical history
    • Extent of the infestation
    • The child's tolerance for specific medications, procedures, or therapies
    • Expectations for the course of the infestation
    • Child or parent’s opinion or preference

    Lice are very treatable. Treatment may include:

    For head lice and pubic lice:

    Application of a medicated cream rinse or shampoo is usually an effective treatment for head and/or pubic lice. The specific instructions need to be followed. Examples of medicated cream rinses or shampoos include the following:

    • Permethrin or Nix® cream rinse
    • Lindane
    • Kwell® shampoo
    • Pyrethrins or RID® gel
    • Nits need to be removed from the hair with a fine-tooth comb

    Combs and brushes should be soaked in hot water with the shampoo for at least 15 minutes.

    Children can return to school or daycare the day following their first treatment for head lice.

    For body lice:

    • Medications are usually not needed to treat body lice
    • Treatment for body lice usually consists of improving hygiene and washing clothes
    • Bed sheets and blankets should be washed in hot water and dried in a hot dryer
    Children's Team

    Children's Team





    The Division of Dermatology at Children's National Health System continues to expand services as more families seek our expertise in the diagnosis and treatment of disorders of the skin, hair, and nails.