Doctors are reporting a surge in scabies cases across the UK amid an acute shortage of treatments, and say the “nightmare” situation poses a major public health threat.
Scabies is a highly contagious condition caused by mites, that results in an itchy rash. It is spread through close skin contact, anyone can get it, and it should be treated quickly to stop it spreading.
In the UK, two main treatment options exist: permethrin and malathion. A combination of supply chain problems, the war in Ukraine and a rise in the cost of raw materials has resulted in months-long shortages of both.
It has sparked an emerging public health crisis, with dermatologists and GPs struggling to treat people with scabies swiftly, the Guardian has been told, with the north of England seeing double the normal amount of cases in November.
Medics are reporting the rise amid concerns that a failure to quickly treat those affected is causing the condition to spread.
Dermatologists who spoke to the Guardian said the situation had become an “absolute nightmare”, with outbreaks in care homes, nursing homes and university accommodation.
National tracking of patients with scabies was “very limited”, a dermatologist leader said, suggesting the problem could be worse than feared.
Some patients have become so desperate they have sought to buy hugely expensive alternative treatments on the internet from outside the UK.
Prof Mabs Chowdhury, the president of the British Association of Dermatologists, said: “The shortage of scabies treatments is something that urgently needs more attention. The public health calculation is not particularly complex – scabies spreads easily and if people aren’t treated, then it will continue to spread. Unfortunately, the consequences of treatment shortages are proving easy to ignore. There is very limited tracking of scabies cases and people are often embarrassed to talk about it.
“A major concern is scabies spreading in care homes, university halls of residence, and other communal living facilities. This makes treatment much more difficult. 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.”
A survey by the British Association of Dermatologists commissioned by the Guardian found that eight of its nine regional representatives had reported an increase in scabies in their area this year. Seven of nine reported shortages of permethrin and malathion.
A dermatologist in the north-east said the shortages were resulting in a vicious circle. “The lack of availability is likely leading to increased spread of infection, which again requires further scabetic treatment and increases strain on demand.”
Chowdhury said cases were likely to increase further as people spent more time indoors together over the winter months. “In the meantime, the shortage of treatments puts enormous strain on people with scabies, some of whom have resorted to buying treatments online at inflated prices,” he added.
Prof Kamila Hawthorne, the chair of the Royal College of GPs, said that while scabies itself was not a serious condition, it could be very irritating and if not properly treated could spread and increase the risk of infection or make existing conditions such as eczema worse.
“It can also affect a patient’s quality of life, so quick treatment is important,” she said. “Since July, GPs have seen a growing rate of scabies presentations – at a consistently higher level than the five-year average and the seasonal norm. This has been particularly pronounced in the north of England. At the end of November, the rate of scabies was three cases per 100,000 of the population which is double the seasonal average.”
She added: “The treatment for scabies is a topical cream or lotion that can be purchased in pharmacies, or by prescription in general practice. However, there have been reports of shortages in the two most commonly used medications, permethrin cream and malathion lotion. When any prescribed medication is unavailable, or in short supply, it is worrying for GPs, pharmacists and patients alike.
“GPs and pharmacists are already under enormous pressures to provide care for their patients during the peak season, and any medication shortages, even if they are only temporary, make the situation worse.”
Dr Tess McPherson, the president of the British Society for Paediatric and Adolescent Dermatology, said it was vital to emphasise that people did not get scabies because they were unhygienic. “We must reduce any stigma associated with having scabies so that people do seek treatments when needed.”
Anyone could get the condition, she said. Including, as it turns out, her son, a student at Cambridge University. “I was a little bit surprised to diagnose it in my own son, but maybe not that surprised given that I am now seeing cases of scabies much more regularly in children and young people.”