The UK is currently facing a significant surge in cases of scabies, a skin condition caused by microscopic mites that burrow under the skin. Despite being centuries old, scabies remains a public health challenge due to its persistent symptoms, high contagion, and frequent misdiagnoses.
Scabies is characterized by intense itching, which worsens at night, and the presence of raised bumps or marks. Unlike bed bugs, the mites responsible for scabies are invisible to the naked eye and are not linked to poor hygiene. The condition spreads primarily through prolonged skin-to-skin contact, making close environments such as care homes, university dormitories, and households hotspots for outbreaks.
Dr Tess McPherson of the British Association of Dermatologists highlights that many people do not seek medical advice promptly, leading to underreporting and delayed treatment. She also stresses the importance of dispelling the stigma around scabies, calling it a “medieval disease” that continues to affect people irrespective of background, and emphasizing that effective treatment is widely available.
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Most cases can be treated successfully with topical creams and lotions available over the counter. However, if symptoms persist, doctors may prescribe oral ivermectin. Proper treatment requires that everyone in the affected household is treated simultaneously to prevent reinfection. Bedding and clothing should be washed at high temperatures or sealed away to kill mites.
Dr Donald Grant, a GP in Wales, notes the increasing prevalence of scabies has been linked to factors such as treatment delays, closer interpersonal contact following the pandemic, and social stigmas that hinder patients from seeking help. Data shows a marked rise in scabies consultations, with Wales reporting over 12,000 cases in 2023-24 compared to just over 1,300 five years earlier.
Symptoms may take several weeks to manifest, complicating timely diagnosis. The mites favor warm, moist areas like the webs of fingers, wrist creases, underarms, groin, and genital regions. Crusted (Norwegian) scabies, a rare and highly contagious variant, affects individuals with weakened immune systems.
Consultant dermatologist Dr Aleksandar Godic explains that visible signs include small burrow tracks on the skin, red and inflamed patches, intense nocturnal itching, and scaly scratch marks often mistaken for eczema or dermatitis. Prompt medical attention is essential if symptoms intensify or if multiple household members experience itching.
Treatment usually starts with permethrin cream to eradicate mites; malathion lotion or oral ivermectin may be used in persistent or severe cases. Even after mites are killed, itching may continue due to allergic reactions, which can be managed with prescribed steroid creams.
Preventing scabies involves minimizing prolonged direct skin contact with infected individuals and not sharing clothes or bedding. Maintaining good personal hygiene and regular handwashing in high-risk settings further reduces transmission.
While scabies is not typically life-threatening, early recognition, proper treatment, and addressing social stigma are vital to controlling this unsettling condition.