A real head scratcher: how scabies returned to the UK

Cases of scabies are rising across the UK, with health experts struggling to account for the sudden increase.

In the second week of January, GPs reported just under 900 cases of scabies across England, which was nearly 20% higher than the same period the year before. And as doctors are only required to report cases of scabies in communal settings, like nursing homes, the total number of cases in England right now is likely to be much, much higher.

What is scabies?

When you hear scabies mentioned, you may think of a “Victorian-era” disease, symptomatic of “dirty conditions” and “bad housing”, said Clare Wilson in The i Paper. “If so, you’d be wrong”: firstly, it is thought to have been identified in Roman times, and secondly, scabies can affect anyone, irrespective of hygiene levels.

The itchy rash is caused by microscopic mites that burrow, live, and reproduce in the skin. Invisible to the human eye, they are around 0.4mm in diameter, and can burrow around 2.5cm – roughly the length of a fingertip – into your skin. The mites can also survive up to 36 hours outside the body. Only 10 females are needed to cause a significant outbreak, which can linger for months, and even years, if not treated correctly.

The itchy bumps, rash and discoloured “burrow” lines are an allergic reaction to the faeces of the mites, and “while not a serious condition, scabies can be very itchy and irritating”, said the BBC. This can exacerbate existing skin conditions like eczema, or cause secondary bacterial and skin infections.

Why is it spreading so quickly now?

The short answer is that there is no one, simple, cause for the spread. While there is “no definitive reason” behind the scabies rise, the back-to-school rush in September can kick-start transmission, as can the Christmas season, where “close contact in shared spaces is common”, Donald Grant, GP and senior clinical advisor at The Independent Pharmacy, told Women’s Health.

Scabies is often mistaken for an STI, as the groin area is “one of the most commonly affected” places, said The Guardian. Between 2023 and 2024, sexual health services registered a 44% increase in diagnoses of scabies – 4,872 up from 3,393. The mites are often transferred through “prolonged skin-to-skin contact”, so sexual partners are much more likely to be infected.

Numbers have kept creeping up since the Covid pandemic, which has left doctors “scratching their heads”. More and more contact, and fewer constraints on socialising, could have led to a “potential ‘ping-pong’ effect”, where “individuals are continuously reinfested within households or close groups of friends”. As symptoms can take “four to six weeks to develop”, and are most contagious before symptoms show, bugs can “lurk undetected while those affected are most contagious”.

Other factors in the spread include the “strain on NHS GP waiting lists”, and “lack of guidance and redirection to pharmacies”, Michael Marks, Professor of Medicine at the London School of Hygiene & Tropical Medicine, told the newspaper.

How to prevent and treat it?

The most common treatment is permethrin cream – also known as Lyclear – which “paralyses and kills the mites”, Hanna Yusuf, prescribing pharmacist at Chemist4U, told Cosmopolitan. The online pharmacy saw “year-on-year sales almost double” in January, “reflecting how many people are seeking treatment right now”. Available on prescription, the cream is applied all over the body from the neck down, and left for eight to 14 hours before being washed off. It often needs to be reapplied a week later, to kill off any eggs that have hatched into mites during that period.

Contaminated items that can’t be washed “should be sealed in a plastic bag for at least 72 hours”, and it is recommended to “vacuum mattresses, sofas and carpets” if there has been any contact.

To mitigate and prevent outbreaks, the NHS advises washing bedding and clothing at 60C or higher, followed by hot tumble drying if available, said The Guardian. If an outbreak has occurred, you should avoid close contact, and stop sharing bedding, towels or other material until the mites have been eradicated.