Scabies and the microbiome – How our microbes play a role in the skin disease

Scabies (medically known as scabies ) may be considered an "old" disease, but it is by no means extinct. In recent years, it has been on the rise in many regions of the world, including Germany. While the cause is clear—a tiny parasite called Sarcoptes scabiei —the influence of the microbiome on the course, severity, and treatment of scabies has so far received little public discussion. However, new studies show that our body's microbiome plays a central role in defense against infections, skin health, and the immune response —all factors that are crucial in scabies.

What is scabies?

Scabies is caused by the itch mite (Sarcoptes scabiei var. hominis) – a microscopic parasite that burrows into the upper layer of skin. The female mite lays its eggs. The mite infestation triggers a strong immune response , which manifests itself in the form of:

• extreme itching (especially at night)

• Redness, pustules, skin nodules

• sometimes crusts and secondary infections

Scabies is highly contagious and is transmitted primarily through close skin-to-skin contact – for example, when sleeping in the same bed, in nursing homes, daycare centers, or during sexual intercourse.

The skin microbiome: The first layer of protection

Our skin is not sterile. Quite the opposite: It is home to millions of microorganisms , including bacteria, fungi, and viruses. This skin microbiome is as individual as a fingerprint and protects us in many ways:

• It forms a barrier against pathogens by competing with them for space and nutrients

• It helps to keep the pH of the skin stable

• It modulates the immune system and prevents excessive inflammatory reactions

• It supports wound healing

Healthy skin is in balance.

If this is disturbed – for example by antibiotics, excessive hygiene, stress or skin diseases – dysbiosis can occur, i.e. a shift in the microbial balance in favor of harmful germs.

What happens to the skin microbiome in scabies?

Studies show that the scabies mite itself and the immune response it triggers can significantly alter the skin microbiome. The mite:

• carries its own bacteria into the skin , especially streptococci and staphylococci

• causes mechanical damage to the skin, which makes it easier for pathogenic germs to penetrate

• triggers an inflammatory reaction that destabilizes the microbial balance

Possible consequences:

• Secondary infections with Staphylococcus aureus or Streptococcus pyogenes

• Development of impetigo (bacterial skin inflammation), especially in children

• In severe scabies (scabies crustosa), the microbiome can become almost completely unbalanced

Scabies and the gut microbiome – is there a connection?

At first glance, the gut microbiome seems to have little connection to a skin disease like scabies. But a closer look reveals interesting connections :

• The intestinal microbiome is an important regulator of the immune system . A healthy intestinal flora can systemically suppress inflammatory reactions.

• It produces short-chain fatty acids (e.g. butyrate), which have anti-inflammatory effects and also have a positive effect on skin health.

• Some studies suggest that a disturbed gut microbiome (dysbiosis) is associated with a higher tendency to skin diseases such as eczema, acne or psoriasis – possibly also to parasitic skin infections such as scabies.

Although the direct connection between intestinal flora and scabies has not yet been scientifically clarified, there is increasing evidence that people with a healthy intestinal microbiome may be more robust against skin infections and recover faster .

Table: Scabies & Microbiome Overview

6. Treating scabies: What does this mean for the microbiome?

The standard treatment for scabies usually consists of:

• Topical anti-scabies (e.g. permethrin cream)

• Oral agents (e.g. ivermectin) in severe cases or in cases of resistance

• Antibiotics if secondary bacterial infections occur

The problem is:

Many of these active ingredients are non-selective . They not only destroy mites or pathogens, but can also damage the skin and gut microbiome . This can lead to:

• the natural microbial balance is restored with a delay

• the skin remains more susceptible to new infections

• Side effects such as diarrhea, dry skin or itching may occur

How can you protect and strengthen the microbiome in scabies?

1. Gentle skin care after therapy

• Use pH-neutral, microbiome-friendly cleaning products

• no aggressive disinfectants or alcohol-based products

• Moisturizing creams with skin-friendly ingredients

2. Probiotics and prebiotics

• Probiotic skincare can help regenerate the skin microbiome

• Oral intestinal probiotics (e.g. with Lactobacillus rhamnosus or Bifidobacterium ) can support the immune system

• Prebiotic fiber promotes “good” intestinal bacteria and has an anti-inflammatory effect

3. Nutrition

• A gut-friendly diet with plenty of vegetables, fiber, fermented foods and little sugar promotes balance

• Omega-3 fatty acids (e.g. from fish or linseed) have an anti-inflammatory effect

4. Holistic view

• Stress management (because stress affects the microbiome and skin barrier)

• Sufficient sleep and exercise to support regeneration

Conclusion: The microbiome – an underestimated factor in scabies

Scabies is more than just an annoying rash. It's a complex infection involving parasites, bacteria, immune responses, and microbes . The skin microbiome plays a crucial role in the defense and healing process. The gut microbiome could also be a key to improved immune balance and skin health in the long term.

A holistic treatment approach – one that not only combats the mite but also protects and regenerates the microbiome – therefore makes sense. Because a healthy microcosm on and within us is often the best protection against external disease.