Do hot tubs kill scabies? What actually works

Do hot tubs kill scabies? No. Hot tub water should never be hotter than 40°C (104°F), and the mites that cause scabies live inside tiny burrows in the top layer of your skin, where a soak cannot reach them. Water hot enough to kill them would burn you first. The treatment that works is a cream or lotion from a pharmacy.

Below, you will find out why heat fails, what the NHS recommends instead, why the tub should stay closed to everyone else until treatment is finished, and how to deal with towels, robes and the cover. This article is general information, not medical advice.

What is scabies and how does it spread?

Scabies is a skin condition caused by a very small mite. The female mite burrows into the outer layer of the skin to lay eggs, and the body reacts to the mites, their eggs and their waste with an intense itch. Anyone can get it, and it has nothing to do with how clean you or your hot tub are.

The mite is called Sarcoptes scabiei (var. hominis), the human form of the mite. It is only about 0.3 mm (about 1/80 inch) long, so it is barely visible to the naked eye. Most people never see the mites themselves, only the marks and the rash they cause.

Common signs listed by the NHS scabies page include:

• Intense itching, often worse at night
• A rash of small raised spots, which can join up into blotches
• Thin, short lines on the skin where mites have burrowed
• Itching between the fingers, around the wrists, elbows, armpits, waist, groin or ankles
• In babies, young children and older people, spots on the head, neck, face, palms or soles of the feet

A single burrow can be up to about 1 cm (0.4 inches) long. It often looks like a thin, thread-like or wavy greyish line on the skin, sometimes with a small spot at one end where the mite sits.

Scabies mostly spreads through long periods of close skin-to-skin contact, such as living in the same home, sharing a bed or having sex. The contact that usually passes it on is sustained, typically around 10 minutes or more, rather than a brief touch. It can also spread less often through shared bedding, towels and clothing. A brief handshake is unlikely to pass it on.

Symptoms can take several weeks to appear the first time someone is infested, usually about 4 to 8 weeks, because the immune system needs time to start reacting to the mites. That delay matters for hot tub owners, because a person can carry mites and pass them on before they notice anything.

Do hot tubs kill scabies mites?

No, and it is worth understanding why, because the idea that a long, hot soak will clear the problem is common. Relying on it delays proper treatment and gives the mites more time to spread to the people around you.

Why 40°C is not enough

Health guidance from the US Centers for Disease Control and Prevention notes that scabies mites die when exposed to 50°C (122°F) for about 10 minutes. That is for mites on fabric in a washing machine or dryer, not mites in living skin. A hot tub runs at 40°C at most, which is close to body temperature and comfortable for the mites.

Soaking for longer does not make up for the lower temperature. Research on scabies mites found that temperatures below 50°C failed to kill them even with extended exposure. A longer soak at 40°C brings no benefit against the mites, only a greater risk of overheating.

That same 50°C for 10 minutes kills mite eggs as well as adult mites. This is why a hot wash works so well on towels and bedding: it clears both the mites and the next generation waiting to hatch.

Even if the water were hotter, the mites sit inside burrows under the surface of the skin. Water does not flush them out, and the skin protects them from heat. To raise the temperature inside your skin to a level that harms mites, you would scald yourself.

Never raise your hot tub above 40°C to try to treat scabies or any other skin problem. Hotter water can cause overheating, fainting and burns, and it will not kill the mites. Keep to your manufacturer's maximum setting and see our hot tub safety rules for safe soaking times.

What about hot showers and hot baths?

The same applies. A shower or bath you can stand in or sit in is far too cool to affect mites in your skin. Washing will not cure scabies, although keeping clean is still sensible while you treat it.

A hot shower or hot bath typically reaches about 38-43°C (about 100-110°F) at its hottest, and most people find anything above that painful. That is still well below the 50°C needed to kill mites, even before you allow for the skin shielding them inside their burrows.

A shower is even less effective than a soak. The water only touches each patch of skin for a few seconds as it runs off, far short of the sustained 10 minutes that heat needs to kill mites even on fabric.

Heat does work on fabric, which is why it plays a part in cleaning your home. The table below shows where heat helps and where it does not.

Can you catch scabies from a hot tub?

The water itself is not a recognised way for scabies to spread. Scabies mites need human skin to survive, and they do not live freely in water. Properly sanitised hot tub water is a poor place for them.

The real risk is the people. A hot tub puts several people close together, often shoulder to shoulder, for twenty minutes or more. Guests then share towels, robes and headrests. That is exactly the kind of close contact and shared fabric that scabies uses to move from one person to the next.

Can scabies survive in a hot tub?

Away from a human body, scabies mites usually survive only 2-3 days. They are unlikely to last long in water that has the right sanitiser level, and there is no good evidence that a well-maintained tub keeps an infestation going.

Crusted scabies is the exception worth knowing about. It is a severe form, usually in people with weakened immune systems, where the skin carries very large numbers of mites and sheds them in flakes. It is far more contagious, so if anyone in your home has been told they have crusted scabies, follow the cleaning advice from their doctor closely.

Is it scabies or a hot tub rash?

Itchy spots after a soak are more often caused by the water than by mites. Folliculitis, a bacterial infection of the hair follicles, usually appears within a day or two of using a poorly balanced tub, often in areas covered by a swimsuit. Our guide to hot tub rash symptoms explains the differences, and you can read how to prevent hot tub folliculitis with good water care.

Scabies tends to build up slowly over weeks, is worse at night, and affects the hands and wrists in many people. If you are not sure which you have, a pharmacist can take a look.

What does the NHS recommend for scabies?

In the UK, scabies is usually treated with a cream or lotion you can buy from a pharmacy. The first choice is normally permethrin cream at 5% strength, and malathion lotion is used if permethrin is not suitable. A pharmacist can tell you which is right for you and explain the leaflet.

The key point is that everyone in your home needs treating at the same time, even people with no symptoms. Close sexual partners from the last couple of months should be treated too. If one person is missed, the mites can pass straight back.

No treatment kills scabies instantly. Permethrin starts killing mites while it is on the skin, but the second application and the following weeks of settling itch are still a normal part of recovery. Expect a gradual improvement rather than an overnight cure.

How the treatment is usually applied

Always follow the leaflet that comes with your product, because instructions vary between products. The usual pattern looks like this:

1. Plan to treat everyone in the household on the same day, ideally in the evening.
2. Apply the cream or lotion to the whole body as the leaflet describes, including between the fingers and toes, under the nails and around the genitals.
3. Leave it on for the time stated on the leaflet. For permethrin this is usually 8 to 12 hours, and for malathion it is usually 24 hours.
4. If you wash your hands during that time, apply the treatment to them again.
5. Wash the treatment off after the stated time.
6. Repeat the whole treatment 7 days later. The second application kills mites that hatch from eggs after the first.

A soak in the hot tub during the treatment period would wash the cream off your skin before it has done its job. This is one of the clearest reasons to keep the cover on until both applications are finished.

When to speak to a GP

A pharmacist is the right first stop for most people. Speak to a GP instead, or ask the pharmacist to refer you, if:

• You are pregnant or breastfeeding
• The person affected is a child under 2
• The rash looks infected, for example weeping, crusted, hot or painful
• The itching has not started to settle 4 weeks after treatment
• Someone in your home may have crusted scabies

Permethrin is not normally used for babies under 2 months old without specific medical advice. This is another reason very young children should always be seen by a GP rather than treated with a pharmacy product at home.

In some cases, such as crusted scabies or when creams have not worked, a doctor may prescribe tablets. This is a decision for a doctor, not something to try on your own.

The tablet is usually ivermectin, normally given as two doses one to two weeks apart. For crusted scabies, it is often combined with a cream so that mites in the skin are attacked in two ways at once.

Ivermectin works in a different way from a cream. It is absorbed into the bloodstream and reaches the mites from inside the body, rather than acting on the skin surface. For ordinary (classic) scabies, it works about as well as permethrin cream.

The ivermectin dose is set by body weight, usually 200 micrograms per kilogram for each dose. This is why the doctor works out the exact amount for each person, and why tablets prescribed for one family member should never be shared with another.

A doctor may also choose ivermectin tablets when applying a cream to the whole body is difficult, for example for someone with limited mobility. Ivermectin is prescribed off-label for scabies in the UK, which means it is not specifically licensed for this use, so the doctor will explain the reasons and the dose.

In rare cases, for example in young infants or when neither permethrin nor ivermectin can be used, a doctor may suggest a 5-10% sulfur ointment applied over several nights. It smells strongly and can irritate the skin, so it is only used on medical advice.

Easing the itch

The itch often carries on for a few weeks after successful treatment, because the skin is still reacting to dead mites. This does not always mean the treatment has failed. A pharmacist can suggest a soothing cream or an antihistamine to help you sleep.

After successful treatment, itching usually lasts about 2 to 4 weeks before it fades. Itching within that period is normal. If it has not started to ease by the 4-week point, speak to a GP, as you may need further treatment.

Keep nails short and try not to scratch, as broken skin can become infected. Cool, rather than hot, water usually feels better on itchy skin, which is another reason to give the hot tub a rest for now.

Throughout the treatment period, take cool or lukewarm showers and baths rather than hot ones. Hot water widens the blood vessels in inflamed skin and makes the itch worse. Cooler water narrows those widened blood vessels again, which helps to calm the itch.

Other simple steps that can help the skin recover:

• Apply a gentle, fragrance-free moisturiser or emollient to help repair the skin barrier damaged by the mites and by scratching.
• Dab calamine lotion on itchy areas to soothe the skin surface.
• Ask a pharmacist or doctor before using a 1% hydrocortisone cream on inflamed patches alongside the scabies treatment.
• Avoid harsh soaps, perfumed shower gels and other fragranced products while the skin is inflamed, as they can make the itch and irritation worse.

Why keep everyone out of the hot tub until treatment is finished?

The NHS says children and adults can usually return to school or work 24 hours after the first treatment. A hot tub is different from a classroom or office, because it combines long, close contact with shared towels and bare skin. As a technician, I would keep the tub closed to everyone until the whole household has finished both applications.

There are four good reasons for this:

• Close seating in the tub means skin contact between bathers is hard to avoid.
• Guests often share towels, robes and headrests, which can carry mites for a short time.
• Soaking washes the treatment off before it has had time to work.
• Warm water and sanitiser can make itching worse and sting scratched or broken skin.

Hot water can also make inflamed skin more uncomfortable in general. If you live with another skin condition as well, our article on whether you can use a hot tub with eczema or psoriasis covers how heat and sanitiser affect sensitive skin.

Sweating and overheating commonly trigger itch flares in people with scabies. Heat widens the blood vessels and increases blood flow to skin that is already inflamed. A hot tub combines heat, moisture and a long soak, so it is a particularly bad mix for the itch.

A 2021 clinical review of itch in scabies supports this. It found that hot water made itching worse in about 67% of patients, and sweating made it worse in about 73%.

Tell anyone who has shared your hot tub, bed or towels in the last couple of months, so they can watch for symptoms and speak to a pharmacist. Scabies is common and treatable, and it is not a sign of poor hygiene.

How should you wash towels, robes and hot tub covers?

Do this on the day of the first treatment, so that you are not putting clean skin back into contact with mites. The NHS advice is to wash bedding, towels and clothing on a hot wash and dry them on a hot setting. This covers the whole house, not just hot tub towels and robes.

Allow roughly 2 to 3 hours on the first treatment day to wash, dry, bag and vacuum. Planning this time in advance means all of it is done on the same day as the treatment.

Before you start, check your washing machine's manual or programme settings to confirm that the cycle you choose, such as a hot or 60°C cycle, actually reaches at least 50°C. Some eco or quick programmes run cooler than the number suggests, and a cooler wash leaves mites alive in the fabric.

1. Gather every towel, bathrobe, swimsuit and pair of spa slippers that has been used in the last few days, along with all clothing, bedding and pillowcases worn, used or slept on in the 3 days before the treatment date.
2. Check the care labels, then wash anything that allows it at 50°C or higher.
3. Dry the washed items on a high heat tumble dryer setting for at least 20 minutes where the label allows. Do not air-dry items you have washed to get rid of mites.
4. Put anything that cannot be washed hot into a sealed plastic bag and leave it closed for at least 3 days (72 hours). This includes shoes, soft toys, cushions and anything else that cannot go in the machine. Keep the bag closed for the full time.
5. Vacuum sofas, chairs, carpets, rugs and mattresses, then empty or throw away the vacuum bag straight away.
6. Use fresh towels and robes after each application of the treatment, and keep them separate for each person.
7. Repeat the wash after the second treatment, a week later.

There is no need to throw away mattresses or furniture after scabies. In most cases, washing, bagging and vacuuming are enough, because mites die within a few days away from human skin.

The hard cover

A vinyl hot tub cover cannot go in a washing machine, and it does not need to. Mites live on skin, not on vinyl, and they die within a few days without a person to feed on.

Wipe the outside and the handles with warm water and a mild soap, or a cover cleaner approved by your manufacturer. Avoid household bleach and harsh solvents unless your manual says they are safe, because they can dry out and crack the vinyl. Then leave the tub closed and unused for at least 3 days.

Headrests, pillows and thermal blankets

Wipe headrests, grab rails, steps and the top edge of the shell with a spa-safe surface cleaner. If your headrest pillows lift out, check the manual for how to clean them, as some can be removed and washed by hand. A floating thermal blanket can be rinsed with clean water and left to dry.

How do you get your hot tub ready to use again?

You do not normally need to drain the tub because of scabies. The water is not how it spreads, and good sanitiser levels make it a poor place for mites. If a water change was nearly due anyway, this is a sensible time to do it.

1. Wait until everyone who uses the tub has completed both treatments.
2. Wait for any scratched or broken skin to heal before soaking.
3. Test the water and bring it into range: free chlorine 3-5 ppm or bromine 3-5 ppm, pH 7.2-7.6 and total alkalinity 80-120 ppm.
4. Shock the water, following the dose on your product and in your manual.
5. Wipe the waterline, headrests and steps once more with a spa-safe cleaner.
6. Put out freshly washed towels, one for each bather.

Some manufacturers recommend slightly different water ranges, so check your manual if its figures differ from those above. Good everyday habits, such as showering before a soak and not sharing towels, are covered in our guide to hot tub hygiene rules for owners and guests.

When you do go back in, keep the first few soaks short and a little cooler if your skin still itches. If heat makes the itch flare up, wait another week or two.

The short version

• Hot tubs do not kill scabies. The water is too cool and cannot reach mites in the skin, and soaking for longer does not help.
• Hot showers and baths, at about 38-43°C at their hottest, are also well below the 50°C needed to kill mites.
• Never raise the temperature above 40°C to try.
• Get 5% permethrin cream or malathion lotion from a pharmacy and treat the whole household on the same day, then again 7 days later.
• If a doctor prescribes ivermectin tablets, the dose is worked out from each person's body weight.
• Take cool or lukewarm showers and baths during treatment to help calm the itch.
• Keep everyone out of the tub until both treatments are finished and broken skin has healed.
• Wash towels, robes, swimwear, clothing and bedding used in the last 3 days at 50°C or higher and tumble dry on high heat, or seal them in a bag for 3 days. Check that your machine's cycle really reaches 50°C.
• Vacuum soft furnishings on the day treatment starts and empty the vacuum bag straight away.
• Wipe the cover and headrests, balance the water and shock before using the tub again.
• Expect itching to last about 2 to 4 weeks after treatment. Speak to a GP if you are pregnant, the patient is under 2, the skin looks infected, or itching lasts beyond 4 weeks.

Frequently asked questions

Can I use my hot tub between the two scabies treatments?

It is best not to. Mites can hatch from eggs during the week between treatments, so you may still be able to pass them on. Soaking also removes any cream still on your skin, and warm, sanitised water can make itching and broken skin feel worse. Wait until the second treatment is finished and your skin has started to settle.

Can I go swimming in a public pool if I have scabies?

Pool water is not a recognised way for scabies to spread, but swimming soon after treatment washes the cream off before it has worked, and changing rooms involve shared benches and close contact. Chlorinated water and sun exposure can also make the itch worse. It is kinder to yourself and others to avoid public pools until both treatments are done and symptoms have settled, and not to share pool towels or toys. Ask a pharmacist if you are unsure.

Do tea tree oil or other home remedies kill scabies?

There is not enough good evidence that tea tree oil, vinegar, bleach baths or other home remedies cure scabies, and some can irritate or burn the skin. The NHS recommends permethrin cream or malathion lotion. Using a home remedy instead of proper treatment usually means the infestation lasts longer and spreads to more people in your home.

Is there anything that draws scabies mites out of the skin?

No. Scabies mites stay in their burrows until treatment kills them, and they only leave to mate or to move to a new person. Soaks, pastes or remedies that claim to pull mites out of the skin do not work, and relying on them only delays proper treatment. A pharmacy cream or lotion, used as directed and repeated after 7 days, is what clears the infestation.

Is scabies a sexually transmitted infection?

Scabies can be passed on during sex because it involves close skin-to-skin contact, but it also spreads through other close contact, such as sharing a bed. It is not caused by poor hygiene. Pubic lice are a different problem caused by small insects, not mites. A sexual health clinic can check for both and advise on treatment for you and your partners.

Should I drain and refill my hot tub after someone had scabies?

It is not normally needed, because scabies spreads through skin contact and shared fabric rather than the water. Balancing the water, shocking it and wiping the surfaces is usually enough. If the water was close to its regular change date, or someone in the home had crusted scabies, a full drain, clean and refill gives extra peace of mind.

Why am I still itching weeks after scabies treatment?

Itching often continues for about 2 to 4 weeks after successful treatment, because the skin keeps reacting to dead mites and their waste. A pharmacist can recommend a soothing cream or antihistamine. If the itch has not started to ease 4 weeks after treatment, new burrows appear, or the skin looks infected, speak to a GP, as you may need further treatment.