In recent months, Naveed Ijaz, a general practitioner specializing in dermatology in Manchester, UK, has observed a rising number of patients at his clinic with intensely itchy rashes caused by scabies, a highly contagious skin condition. The Sarcoptes scabiei mite, responsible for scabies, leads to itchy rashes spreading across the body. Dr. Ijaz expresses concern over the shortage of available treatments, particularly as outbreaks tend to increase over winter when people spend more time indoors.
While scabies is a common condition affecting around 200 million people globally, cases in England are surging above typical levels, with outbreaks reported in care homes and university accommodations, especially in the northern part of the country. Kamila Hawthorne, chair of the UK’s Royal College of GPs, notes that incidences in the north remain higher than national and five-year averages. The recent surveillance reports detail 1,926 cases across the country between December and January.
The increase in scabies cases is part of a broader, ongoing trend observed across Europe and globally for the past decade. Unlike other infectious diseases, the rise in scabies is not attributed to climate change but is influenced by factors such as treatment shortages, treatment failure, and the persistent stigma surrounding the disease.
Scabies mites, if not treated, can reproduce, burrow, and lay eggs under the skin, causing continuous cycles of itching and sores. Transmission is easy, especially through skin-to-skin contact, such as during sexual activity. The mites can also spread by crawling onto furniture and bedding, contributing to sustained outbreaks in places like schools, prisons, and care homes.
The primary treatments for scabies, permethrin, and malathion, are skin lotions that must be applied to the entire body to eliminate mites and eggs. However, there are increasing reports of treatment failure, with a review indicating a failure rate of up to 30%. Drug resistance among mites is emerging as a concern, though it remains poorly understood.
The difficulty of eradicating scabies outbreaks is compounded by the need to decontaminate bedding and furniture. Additionally, the application of treatments like permethrin is challenging, contributing to treatment failures. In the UK, a severe shortage of treatments lasting several months further hampers efforts, attributed to pandemic-related supply chain issues and Brexit-related import problems.
Researchers emphasize the need for rigorous surveillance of potential scabies outbreaks due to its high incidence. Untreated scabies can lead to secondary skin infections, particularly in vulnerable populations like those in care homes, potentially causing organ damage. The stigma surrounding scabies as a "disease of the unwashed" has contributed to its neglect and misinformation, such as blaming disadvantaged populations for its spread.
While effective oral medication exists for scabies in the global south, it is not routinely used in the UK due to false claims about its effectiveness against COVID-19. Researchers hope to promote the use of this medication for scabies, emphasizing the importance of accurate information to combat misinformation. In the meantime, doctors aim to manage the current outbreak in the UK through more effective public health campaigns to prevent mismanagement and shortages.
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