When Jane Mundye rang her GP in tears over her incessant itch, she was at her wits’ end. Having first gone to her doctor in August last year with what she assumed were insect bites, she was told it was an allergy and given antihistamines.
But when they failed to make a difference after several weeks, Jane, 77, begged her GP to have another look. ‘I was becoming obsessed with my scratching,’ she said. ‘I rang in tears. But he said, “Well, what do you want me to do?”’
It was only when Jane went in desperation to her local pharmacist that she received a very different diagnosis.
She was suffering from scabies – an intensely itchy rash caused by microscopic mites that burrow into the skin to lay eggs – which is spread by close contact with infected people. Often described as a Victorian disease, the latest figures show that scabies is on the rise again this winter in Britain, as it has been for several years.
GPs have reported a 20 per cent increase in the number of cases compared with the same time last year, while there has been a significant surge since 2023, according to the UK Health Security Agency.
Like many patients Jane, from Dorset, has no idea how she picked up the mites. ‘To this day I don’t know how I got it,’ she said. ‘Let’s face it, no one is going to own up to it. I can’t tell you how much it’s affected me – I’m just relieved it’s gone.’
Last week, The Mail on Sunday’s GP columnist, Dr Ellie Cannon, wrote of concerns that the main treatment being given – a cream called permethrin – no longer worked because the bugs had become resistant to it.
When Mail on Sunday columnist Dr Ellie Cannon wrote about concerns over the cream permethrin last week, it prompted dozens of readers to write in about their own experiences with scabies
Experts say the main problem with permethrin, which has been the first line treatment for decades, is it must be applied correctly to work – and doing so is onerous
Many scabies sufferers are repeatedly misdiagnosed with other problems such as allergies or skin conditions such as eczema or psoriasis
It prompted dozens of readers to write in about their own experiences with the parasitic infection. And it gave an intriguing insight into what might be driving the wave of infections.
In some cases, readers such as Jane are being repeatedly misdiagnosed with other problems such as allergies or skin conditions such as eczema or psoriasis, and only finally diagnosed with scabies weeks or months later – after the problem has worsened and potentially spread to others.
One man revealed that he suffered from itchy skin for three years and was repeatedly told it was ‘allergies’ until he was diagnosed with scabies by a dermatologist.
But, tellingly, others have also revealed that permethrin had failed to get rid of the problem.
So what is going on? Experts say the main problem with permethrin, which has been the first line treatment for decades, is it must be applied correctly to work – and doing so is onerous.
It must be slathered all over the body, left on for 12 hours, and repeated a week later to catch any new eggs. Entire households must also be treated at the same time, even if they have no symptoms, to avoid reinfection.
Professor Michael Marks from the London School of Hygiene and Tropical Medicine, an expert in infectious diseases, said: ‘It’s incredibly hard to apply it properly – to get it into your armpits, under your nails and belly button, and then keep it on.
‘It remains unclear whether or not it really doesn’t work, or it isn’t used correctly, which we call “pseudo-resistance”.’ But as Dr Ellie has noted, there are also ‘plausible reports’ that suggest scabies may be developing some resistance to permethrin.
One 2023 review of the evidence found permethrin treatment failure is increasing by 0.58 per cent a year – double the figure for other treatments. And a 2024 review concluded ‘permethrin-resistant scabies is an escalating threat’.
Professor Tess McPherson, from the British Association of Dermatologists, said: ‘We’re possibly seeing some issues with permethrin as a first-line treatment, and we have to be open to the idea that there might be some resistance.
‘I still think we feel it works for the majority of cases, as long as it’s left on long enough and it’s repeated.
‘But I think if people have had multiple courses of permethrin, other treatments should be recommended.’
The letters to the Mail suggest this often isn’t happening.
An alternative to permethrin, a tablet called ivermectin, is easier to use but is not routinely prescribed. Studies found it can kill the bug and its eggs, and may stop them returning for up to two years.
But it is expensive for the NHS, and many GPs – who may rarely see scabies infections – are not yet aware of a 2024 update which means it can be given as a first-line treatment.
There are several other options, including benzyl benzoate or malathion cream, which can be used if neither permethrin or ivermectin work.
Diagnosing scabies, which are invisible to the human eye, can be tricky because the tell-tale red rash, which typically appears in folds of the skin inside the elbow, knee, buttocks and between fingers and toes, can take months to appear.
Professor McPherson said it was ‘not surprising’ that scabies was misdiagnosed but GPs and patients should be aware it is a possibility given the current outbreak.
