If you’ve heard of the skin disease, scabies, you might think of it as a Victorian-era condition, affecting those living in dirty conditions or bad housing.
If so, you’d be wrong. Scabies can affect anyone, and doesn’t involve poor hygiene.
It is usually passed on by skin-to-skin contact, so, while it is more likely in crowded housing conditions, it is also renowned for causing outbreaks in comparatively well off university student digs, as well as schools and care homes.
And far from being a disease of the past, scabies is on the rise, having shown large increases in the past two years. But doctors are at a loss to explain why. “There are lots of theories, but we don’t know what the answers are at the minute,” said Dr Michael Head, a public health researcher at the University of Southampton.
Scabies is caused by a microscopic mite, almost too small to see with the naked eye. It burrows under the skin, targeting soft areas in the body’s folds and creases like between fingers, behind ears, and in the armpits, belly button and groin.
The main symptoms are an itchy rash and thin, grey or silver wavy lines that show where the mites have tunnelled through the skin.
The condition can be cured with creams or pills, but several treatments may be needed. In the meantime, the mites can be passed on, causing repeated infections – or infestations as they are technically known – within groups.
How scabies mites can spread
The mites are usually caught during skin-to-skin contact, especially by people sharing a bed, so scabies is often treated at sexual health clinics, raising stigma. But it can also be passed between family members and the mites can even survive on soft furnishings for a few days.
So, one person affected means that everyone in a household must use the cream at the same time – even if they don’t have symptoms – and clothes must be washed at 60°C, carpets vacuumed, and so on.
Cases usually rise in winter, probably because people spend more time in close contact indoors. There is no figure kept centrally for all scabies cases in the UK, but data from sexual health clinics in England show a recent uptick.
Cases were broadly level for several years before dipping in the Covid lockdowns. After returning to previous levels, they more than doubled between 2022 and 2023 – and then rose again by nearly 50 per cent in 2024.
The British Association of Dermatologists said a surge in September 2024 could be caused by students returning to university, with cases spreading through halls. “It is important to state that you do not get scabies because you are unhygienic, and there should be no stigma,” said the association’s Dr Tess McPherson.
“As scabies spreads easily by skin-to-skin contact, you should tell people you live with, to help stop this spreading.”
Scabies on a child’s hand. The main symptoms are an itchy rash and thin, grey or silver wavy lines that show where the mites have tunnelled through the skin (Photo: Zay Nyi Nyi/Getty)But why are cases going up year on year? One theory is the mite may be becoming resistant to the main drug used, a permethrin cream. In 2022, researchers in Austria found the standard permethrin treatment gave a cure rate of only 29 per cent, in a small study of 55 people.
But those patients might be more likely to have drug-resistant scabies because they had been sent to a dermatology clinic, said Professor Michael Marks at the London School of Hygiene and Tropical Medicine. Most people are treated for scabies by their GP and might only be referred to dermatologists if treatment fails.
By contrast, a recent French trial found permethrin had a cure rate of 89 per cent, with the second option of ivermectin tablets only curing 72 per cent.
What might really be responsible for permethrin cream failing could be something doctors call “pseudo-resistance” – which means it doesn’t work because people aren’t using it properly.
Are people using the cream all wrong?
To be fair, this is a difficult ask. You have to rub the cream all over your body, from your ears downwards, getting every crease, including your genitals and your bottom. It needs to stay on for at 12 hours – and if you wash your hands in that time, you must reapply it. “It’s just very hard to get all the cream on for 12 hours,” said Professor Marks.
The application must be done twice, one week apart. And what’s more, every member of the household and/or sexual contacts need to do it at the same time.
Even people who don’t have symptoms could be harbouring the mites, said Dr Head. “It takes about a month for symptoms to appear. You can transmit in that month. So that makes contact tracing challenging and getting outbreaks under control challenging.”
It is especially tricky tackling outbreaks among students, Professor Marks said. “[Imagine] trying to treat an entire hall of residence.”
There are other possible explanations for the rise in scabies. There were shortages of the main treatments in 2023 and 2024. These have now resolved but we could still be seeing after effects
It may be tempting to blame longer waits to see a GP – but other European countries are reporting increases, including Spain, Italy and The Netherlands.
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Another factor could be that stigma is reducing, meaning that more people are going to the doctor for treatment, said Dr Head. “Whether people do go and seek seek treatment is going to be a factor that influences the level of reporting, and therefore the numbers that we see.”
Professor Marks said that we should not be too quick to assuming there is drug resistance. “The most popular version of any story [about disease] is always that there is a new variant. But life is complex and multifactorial, and there are probably lots of things that all contribute.”
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