Public Urged to Stay Vigilant as Scabies Cases Spike Across the UK
The public is being urged to remain highly alert following a sharp and concerning rise in cases of scabies across the United Kingdom. This highly contagious skin condition, once widespread in Victorian Britain, causes intense and persistent itching that can severely impact quality of life.
A Microscopic Mite Causing Major Disruption
The disease is caused by microscopic mites that burrow into the skin. It spreads easily through prolonged close contact, meaning entire households, care homes, and student accommodation blocks can be quickly and severely affected. The hallmark symptom is an intense itching, often worst at night, which can drive sufferers to despair.
Alarming Data Shows National Surge
Latest figures from the Royal College of General Practitioners' Research and Surveillance Centre reveal that consultations for scabies are now running at double the five-year national average. In parts of northern England, the rates are higher still, indicating a significant regional burden.
In the past week alone, GPs recorded just under 900 cases across England – a figure almost 20 per cent higher than during the same week last year. Separate data from the UK Health Security Agency shows diagnoses at sexual health clinics rose by a staggering 44 per cent between 2023 and 2024.
Frontline Clinicians Sound the Alarm
Dr Lewis Haddow, a consultant in HIV and sexual health at Kingston Hospital NHS Foundation Trust, stated he was 'seeing scabies all the time', highlighting the sheer volume of cases presenting to services. Patients have described their ordeal as 'hell', with many saying they 'wouldn't wish it on my worst enemy'.
Understanding Transmission and Diagnosis Challenges
Scabies is primarily spread through skin-to-skin contact and is commonly passed on during sex, although it is not officially classified as a sexually transmitted infection. Symptoms usually appear three to six weeks after initial infection, but can develop within days in people who have had scabies before.
Diagnosis can be notoriously difficult. The characteristic rash – typically affecting skin folds such as the elbows, knees, buttocks, and the spaces between fingers and toes – may take weeks or even months to appear. Persistent scratching can aggravate pre-existing conditions like eczema and psoriasis, while also increasing the risk of serious secondary bacterial infections.
Vulnerable Groups and Severe Forms
People with weakened immune systems are particularly vulnerable to a more severe form of the disease known as crusted scabies. This involves far larger numbers of mites and presents a greater challenge for treatment and containment.
Experts Identify Key Drivers of the Outbreak
Experts believe the current surge may be linked to a perfect storm of factors:
- Shortages of first-line scabies treatments, such as permethrin and malathion, two years ago.
- Increased social mixing in the aftermath of the COVID-19 pandemic.
- Lengthy NHS waits for assessment and treatment, allowing the infection to spread unchecked.
Professor Michael Marks, a medicine professor at the London School of Hygiene & Tropical Medicine, noted that similar trends are being observed across Europe. He identified likely drivers including outbreaks in crowded settings like university halls of residence and hostels, coupled with systemic delays in diagnosis and failures to effectively trace and treat close contacts.
Treatment Challenges and Emerging Resistance
For decades, the first-line treatment has been permethrin cream, applied over the entire body and repeated a week later to kill newly hatched mites. A critical part of the protocol is that all close contacts must be treated simultaneously, even if they show no symptoms.
However, there is now mounting evidence that the mites are developing resistance. A 2024 review in the Journal of Clinical Medicine warned starkly that 'permethrin-resistant scabies is an escalating threat'.
Newer Treatments and Associated Controversies
An oral anti-parasitic drug, ivermectin, was approved as an NHS treatment for scabies in 2023. While easier to administer than topical creams, it is more costly and some specialists do not consider it more effective. The drug also attracted significant controversy during the Covid pandemic due to unfounded claims it could treat the virus, leading to it being misleadingly labelled a 'horse dewormer'.
Studies suggest ivermectin can kill both mites and eggs and may prevent reinfection for up to two years, although a small minority of patients experience side effects including dizziness or a rash that mimics the infection itself.
The Dire Consequences of Inaction
Without prompt and effective treatment, scabies can persist for months or even years as mites continue to reproduce. The parasites can also survive in bedding, clothing, and towels, creating a persistent reservoir for the infection to spread further within communities and households.
The profound impact on mental health and daily life cannot be overstated. One recently affected patient told The Guardian: 'It was hell. My mental health was in the pan, the scratching, the itching drives you insane, and the cleaning and laundry, and you feel you can't talk to anybody … It affected our lives so horrendously.'
This testimony underscores the urgent need for public awareness, timely access to effective treatments, and a coordinated public health response to curb this Victorian disease's alarming return.
