The public is being urged to remain alert after a sharp rise in cases of scabies – a highly contagious skin condition once widespread in Victorian Britain that causes intense, persistent itching.
The disease is caused by microscopic mites that burrow into the skin and spread easily through prolonged close contact, meaning whole households, care homes and student accommodation can quickly be affected.
Latest figures from the Royal College of General Practitioners’ Research and Surveillance Centre show consultations for scabies are now running at double the five-year national average. In parts of northern England, rates are higher still.
In the past week alone, GPs recorded just under 900 cases across England – almost 20 per cent more than during the same week last year.
Separate data from the UK Health Security Agency shows diagnoses at sexual health clinics rose by 44 per cent between 2023 and 2024.
Dr Lewis Haddow, a consultant in HIV and sexual health at Kingston Hospital NHS Foundation Trust, said he was ‘seeing scabies all the time’.
Patients have spoken of their ordeal with scabies, describing it as ‘hell’ and saying they ‘wouldn’t wish it on my worst enemy’.
Scabies is spread through skin-to-skin contact and is commonly passed on during sex, although it is not classified as a sexually transmitted infection.
The public is being urged to remain alert after a sharp rise in cases of scabies – a highly contagious skin condition once widespread in Victorian Britain that causes intense itching
Symptoms usually appear three to six weeks after infection, but can develop within days in people who have had scabies before.
The hallmark itching is often worst at night.
Diagnosis can be difficult because 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 conditions such as eczema and psoriasis and increase the risk of secondary bacterial infection.
People with weakened immune systems are particularly vulnerable to crusted scabies, a more severe form of the disease involving far larger numbers of mites.
Experts believe the surge may be linked to shortages of scabies treatments such as permethrin and malathion two years ago, alongside increased social mixing after the pandemic and lengthy NHS waits for assessment and treatment.
Professor Michael Marks, a medicine professor at the London School of Hygiene & Tropical Medicine and former chair of the International Alliance for the Control of Scabies, said similar trends were being seen across Europe.
Likely drivers include outbreaks in crowded settings such as halls of residence and hostels, as well as delays in diagnosis and failures to trace and treat close contacts, he said.
For decades, first-line treatment has been permethrin cream, applied over the entire body and repeated a week later to kill newly hatched mites. All close contacts must be treated at the same time, even if they have no symptoms.
However, mounting evidence suggests the mites are developing resistance. A 2024 review in the Journal of Clinical Medicine warned that ‘permethrin-resistant scabies is an escalating threat’.
An oral anti-parasitic drug, ivermectin, was approved as an NHS treatment for scabies in 2023. While easier to use, it is costly and some specialists do not consider it more effective than topical creams.
The drug attracted controversy during the Covid pandemic after unfounded claims it could treat the virus, leading to it being 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 number of patients experience side effects including dizziness or a rash resembling the infection itself.
Without prompt and effective treatment, scabies can persist for months or even years as mites continue to reproduce – and can survive in bedding and towels, allowing the infection to spread further.
One patient who had recent been affected 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, I wouldn’t wish it on my worst enemy.’
