Doctors report ‘nightmare’ surge in scabies amid shortage of medicines to treat the highly contagious itchy skin condition that’s caused by tiny mites

• In November the scabies rate was double the seasonal average, GP data shows 
• Experts said shortages of scabies medication ‘urgently needs more attention’ 

A ‘nightmare’ surge in scabies cases poses a major public health concern, experts warned today. 

Scabies is an intense itchy and bumpy rash caused by the saliva, eggs and faeces of the parasitic mite Sarcoptes scabiei, with symptoms sometimes lasting for months. 

It is highly contagious and can sweep through shared accommodation, such as university halls, care homes, prisons and immigration detention facilities.

Infection rates in the UK have doubled in a year, with doctors fearing that a failure to treat the condition quickly, amid medication shortages could spur on the outbreak. 

Experts also fear the resurgence of the Dickensian disease may be driven by the parasite becoming resistant to existing medications, or sufferers failing to correctly treat their condition.

Latest surveillance data from the Royal College of General Practitioners (RCGP) shows there were three cases per 100,000 people in November, double the seasonal average. 

In the week beginning November 27, 27,484 cases were recorded by 500 GP practices in England and Wales that monitor the rash. 

For comparison, just 56 cases were recorded during the same week in 2021, while 94 were logged that week in 2022.  

Professor Mabs Chowdhury, president of the British Association of Dermatologists, told MailOnline: ‘Scabies is a common, yet highly contagious skin condition. 

‘The ease with which it spread, particularly in group living facilities like care homes and university halls of residence, is alarming given the shortage of effective treatments. 

‘We have called on regulators, such as the MHRA and the Government, to give the necessary support to manufacturers and suppliers to ease bottlenecks in production.

What is scabies? 

Scabies is a skin condition caused by an immune reaction to the mite Sarcoptes scabiei and their saliva, eggs and faeces. 

Typical signs of infection are an intense itching associated with burrows, nodules and redness in the skin.

The incubation period is up to eight weeks after contact with an affected person. 

Skin penetration is commonly visible as tiny linear burrows containing the mites and their eggs. 

Scabies is most often transmitted by prolonged or frequent skin-to-skin contact, such as sex or the sharing towels, bedding, or clothing.

The infection is incurable without treatment. 

‘Whilst we have been advised that more supplies of permethrin and malathion are going to become available early in the new year, we must ensure that an adequate supply of effective treatments is maintained.’

He said: ‘There is very limited tracking of scabies cases and people are often embarrassed to talk about it.’

‘Given the challenges in social care and the treatment shortages, public health bodies need to plan for outbreaks in care facilities.’

He added: ‘The public health calculation is not particularly complex — scabies spreads easily and if people aren’t treated, then it will continue to spread.’

NHS guidance recommends using either permethrin or malathion creams, which must be rubbed all over the body, including under the nails. 

It should be kept on for up to 24 hours and has to be repeated after a week.

As an alternative, evidence suggests ivermectin — taken in pill form — is safe and equally as effective. 

European regulators recommend it in two doses two weeks apart for standard scabies. It can be used alongside the creams for more severe cases.

In the UK, however, a prescription can be issued only by a specialist — usually a dermatologist — for severe cases, or to treat an outbreak, according to the UK Health Security Agency (UKHSA).

But in September the Department of Health issued an alert warning that permethrin, was in short supply while malathion liquid was also unavailable. 

Supplies are believed to have been hit by a surge in demand for scabies treatment in both the UK and Europe, as well as a spike in the cost of raw materials. 

A survey published today by the British Association of Dermatologists, which was commissioned by the Guardian, found that eight of its nine regional representatives had reported an increase in scabies in their area last year. 

Seven of nine reported shortages of permethrin and malathion. 

Dermatologists who spoke to The Guardian said the situation had become an ‘absolute nightmare’. 

But experts also warned rising rates of the infection could be in part triggered by a failure to properly treat the condition, creating ‘pseudo resistance’. 

Claire Fuller, co-founder of the Scabies Alliance, told The Times if people were not treating the condition correctly repeatedly, by not being instructed properly, this could cause resistance. 

Scabies cases also differ dramatically across the country, top doctors said today, with the north of England seeing more ‘pronounced’ rates than than the rest of the country. 

Professor Kamila Hawthorne, chair of the RCGP, told MailOnline: ‘Since July, GPs have seen a growing rate of scabies presentations — at a consistently higher level than the five-year average and the seasonal norm. 

‘This has been particularly pronounced in the north of England.’

She added: ‘When any prescribed medication is unavailable, or in short supply, it is worrying for GPs, pharmacists and patients alike.

‘GPs and pharmacists are already under enormous pressures to provide care for their patients during the peak season, and any medication shortages, even if they are only temporary, make the situation worse.’

While scabies is a common condition it often goes undiagnosed, as the rash can be mistaken for a variety of other skin conditions. This increases the risk of an infected person passing it on to others. 

It mainly passes through shared clothing or bedding, as well as through skin-to-skin contact, such as during sex.

Last month, scabies caused four studios at Central Saint Martins, University of the Arts London, to be closed ahead of Christmas deadlines.

At least two cases were reported among students, with the university forced to organise a deep-clean across the studios and fabric room.

Meanwhile, in September several migrants who moved to a former RAF site near Braintree, Essex, were diagnosed with scabies.

The itchy rash is triggered by mite burrowing under the skin to lay eggs, the presence of eggs and the faeces of the creatures. 

This egg-laying can look like a line with a dot at one end before developing into a rash.

While very infectious, it can take up to eight weeks for the most obvious sign, the rash, to appear, meaning people can transmit it unknowingly to others. 

The rash usually spreads to the whole body, minus the head.

Scabies is incurable without treatment and people should avoid work or school until their receive medication, experts say. 

While scabies is not dangerous by itself, scratching of the rash can lead to secondary bacterial infections of the skin.

People with compromised immune systems, such as cancer patients undergoing chemotherapy, are vulnerable to hyper-infestations called crusted scabies.

The UKHSA notes that an estimated one in 50 long-term care facilities, such as care homes, will experience a scabies outbreak each year.