Scabies outbreak made worse because patients reinfecting themselves, doctor warns

A dermatologist has warned the ongoing scabies outbreak is being made worse by an increasing number of people getting persistently reinfected.

Dr Emma Amoafo-Mensah told Yahoo News she has seen an increase in the number of patients referred to her clinic with persistent scabies and that a continued shortage of medicine, people not being seen quickly enough and some patients using the treatment incorrectly were to blame.

"Whilst they are waiting, there's a high risk of them spreading the scabies to those around them, and the problem worsens even more," she said.

Scabies is a rash caused by mites that lay eggs under your skin. It tends to spread on hands, the groin and around the waist and bottom, though it can infect anywhere.

Concerns over an outbreak sharpened in the autumn of 2023, with outbreaks described as a "snowballing" public health issue after incidents were reported in some care homes and universities.

In January, experts warned that shortages of certain medicines were putting patient safety at risk, describing the system is “unviable and broken”, and calling on the Government to recognise the seriousness of the issue. Figures from the Royal College of GPs show that the number of scabies infections in January remained higher than normal across the UK.

According to the British Association of Dermatologists, if scabies isn't treated correctly, the infection could last for months or even years.

Dr Emma Amoafo-Mensah, who works for an NHS hospital and has been a practising dermatologist for four years and a qualified doctor for nine, flagged the growing problem in a TikTok video to her 15,000 followers. She said: "If you're diagnosed with scabies, you need to follow all the treatment instructions to the tee, make sure that treatment gets applied absolutely everywhere on your skin and pay particular attention to places like your hands, your feet, your groin and underneath your fingernails.

"The treatment itself is laboursome, can cause irritation and needs to be repeated after seven days, making adherence difficult for some. If not all contacts are treated, re-infection often occurs."

She said in her video, posted on Tuesday: "Everybody and their grandmother has scabies right now, for some reason scabies rates are just absolutely through the roof at the moment. "

In September, the British Association of Dermatologists (BAD) warned that shortages date back to May 2023 following an increase in demand for treatments in Europe due to supply chain issues and the rising cost of raw materials.

In January, the BAD told the Guardian that the spread of scabies in communal living facilities like care homes and universities in particular was making treatment difficult. Prof Mabs Chowdhury, the president of the BAD, said: "If even one person isn’t treated completely, everyone can be reinfected. Given the challenges in social care and the treatment shortages, public health bodies need to plan for outbreaks in care facilities."

Paediatric dermatologist Dr Tess McPherson, also of the BAD, told Yahoo News on Wednesday that while the overall data on outbreaks was limited as the total number of cases was not monitored, there was "anecdotal evidence" to suggest that the outbreak was ongoing.

She added that shortages of medicine remained: "We are aware that this has been worsened in the past by the lack of effective treatments due to a shortage of the two medications for scabies at the time: permethrin and malathion."

According to Dr McPherson, the UK recently licensed ivermectin, a tablet that can be taken orally instead of the cream.

What are scabies symptoms and how to avoid catching it?

The rash presents itself red and raised and can be darker on skin of colour. It also can cause pustules and red scratches on your skin. One main symptom is intense itching throughout the night. Although scabies is highly contagious, you are safe to make contact with uninfected people 24 hours after you start your treatment.

The creams, permethrin and malathion, can be obtained from a pharmacist, and they work quickly, but it could take weeks before the itching stops.

If someone you know has scabies, not making any physical contact with them or any surfaces they have come in contact with is the safest measure. Experts say washing your hands as often as possible after touching objects that may be infected could lower the chance of catching scabies from someone else who was in contact with those surfaces.

Dr McPherson says: "In terms of tackling scabies, it is important to highlight that anyone can get scabies – it is not a question of poor hygiene, and it does not help to stigmatise this condition as this can lead to delay in getting treatments or ensuring all contacts are treated."

Some people catch scabies after sexual intercourse with someone who has it, and it is considered a non-genital STI.

What to do if you catch scabies

Once you get the medication, the first thing you do is to ensure you follow the instructions per the leaflet with your cream. You can also find the step-by-step information here.

Dr Mensah advises people who get scabies to wash their bedding at high heat and put anything soft that can't be washed in a plastic bag for three days in order to get rid of the mites.

Similarly, Baqir Khan, owner of Proactive Cleaners, suggests making sure your home is thoroughly cleaned to prevent the scabies from spreading. Khan said: "Aim for a minimum of 50C or higher for the water temperature. This temperature is the ideal heat for killing scabies mites and their eggs. Ideally, aim to wash these items at least once a week to minimise the risk of re-infestation."

Read more:

• Doctors report ‘nightmare’ surge in scabies across UK (The Guardian)

• Scabies: UK facing unusually large outbreaks – and treatment shortages appear mostly to blame (The Conversation)

• How to reduce chance of getting scabies amid ‘nightmare’ outbreak (Yahoo)