Louise (not her real name) is listing the contents of a bin liner she has packed with fresh essentials in case of emergency. Clothes, toothbrushes, hairbrushes, a teddy … “Although it should be two teddies,” she re-evaluates, quickly. I can hear her trying to quell her panic.
A diehard survivalist preparing for catastrophe? Actually, a beleaguered 44-year-old mother recovering from scabies – an itchy rash caused by microscopic mites that burrow under human skin. Far-fetched as it sounds, emergency evacuation is exactly what she, her partner and children (six and four) resorted to in November in a desperate bid to beat the bugs. She is now on tenterhooks in case they return.
Telltale spots had appeared in September, first on her own body, later on her son’s and daughter’s. Two rounds of topical treatment followed, alongside a frantic maelstrom of laundry. They were washing clothes and bedding after every use, as well as steaming mattresses, duvets and sofas, churning through hundreds of disposable gloves, “boiling the kids’ crocs”, and quarantining anything else they could think of in bin bags. When all those measures failed, it was time for the nuclear option: they took the kids out of school for a week and rented a caravan near their home in south-west England. They changed into fresh clothes at the door of their home, then travelled by steam-cleaned car, before repeating treatment for a third time. A fresh teddy was needed for their daughter on arrival, and a replacement before leaving.
“It was hell,” she says. “My mental health was in the pan, the scratching, the itching drives you insane, and the cleaning and laundry, and you feel you can’t talk to anybody …” She apologises, fearing she might sound crazed. “It affected our lives so horrendously, I wouldn’t wish it on my worst enemy.”
While extreme, their experience is becoming less of a rarity. If you don’t know someone with the condition, a glance at social media reveals many posts, dogged by the same desperation. They read like SOS calls. Many have endured a very itchy Christmas and can’t see the end. “Please help if you can!” pleads one. “I’m writing this in tears, I’ve had scabies for almost a month now.” Another says she is “not sleeping at all”; still another “I feel like my skin is on fire. I have done so much washing … I feel really low.”
Although it sounds like a long-ago disease – the Roman author Aulus Cornelius Celsus is said to have first named the condition in 25 AD – it seems very much at home in the present day. And, since the pandemic, case numbers have been far higher, leaving many doctors, ahem, scratching their heads.
A 2024 report from the UK Health Security Agency found annual increases from 2021, growing even more significantly since 2023. Scabies is sometimes mistaken for an STI because the groin is one of the most commonly affected areas, and the agency analysed those presenting with scabies at sexual health services – finding a 44% increase in diagnoses between 2023 and 2024 (4,872 in 2024, up from 3,393). The years leading to the pandemic saw a relatively stable 1,500 cases annually, and restrictions on socialising during the pandemic led to a decrease.
Likewise, figures from the Royal College of General Practitioners’ Research and Surveillance Centre show a rise in scabies, especially in autumn and winter months when people spend more time indoors, and return to schools and universities. Its weekly report for England confirms that cases remain stubbornly higher than the five-year national average – peaking at almost double across the final four months of last year. Cases in the north of England are higher still.
Yet few people affected by scabies will initially know anything about the condition – that it is caused by the human mite sarcoptes scabiei var hominis, which is invisible to the eye and burrows into skin at a rate of 0.5 to 5mm a day. There, the females lay their eggs, which hatch after three to four days. Symptoms can take four to six weeks to develop – allowing the bugs to lurk undetected while those affected are most contagious.
When they do finally appear, the key symptoms are itchy bumps and “burrows” or thin lines – tunnels where the female has dug down. They can appear everywhere, but are usually found in skin creases such as between the fingers; they do not often appear on the head, except in young children and elderly people. A rarer form, crusted scabies, which usually affects those with weakened immune systems, is much more visible.
The mites are often transferred through prolonged skin-to-skin contact with other humans, but they can survive outside the body for up to 36 hours. The NHS advises washing all bedding and clothing “at 60C or higher, and if possible in a hot dryer” and putting “clothing that can not be washed in a sealed bag for at least three days until the mites die”. It also stresses the need to avoid sexual or close physical contact until treatment has ended, and to avoid sharing bedding, clothing and towels. Work and school can be resumed once treatment has begun.
Louise hopes she is now in the “post scabies itch” phase, which can, confusingly, continue for a few weeks after the mites die. Her children have recovered. When she first discovered symptoms, she was shocked. “I first thought of it as a dirty thing,” she says. “I was ashamed.” In fact, scabies has no connection to poor hygiene.
Louise’s GP prescribed permethrin, a synthetic insecticide which can also be bought at pharmacies. The cream must be applied across the body and left for eight to 12 hours before washing – in two doses, a week apart. Cohabitants and close physical contacts are advised to follow the same treatment. However, after this first treatment, Louise’s spots spread across her body and her son also developed a spot, so she returned to the GP about a month later, receiving even more permethrin.
Meanwhile, their home became a battleground. “It was bin bags and bin bags of washing every day … the dryer and washing machine were going day in, day out,” she says. It was only during this second treatment period that they realised they had to bag up coats, hats, shoes … “Nobody told us about that stuff.”
Regardless, her daughter then showed symptoms and Louise wasn’t improving. By mid-November, she pleaded to try other remedies: another insecticide cream, malathion, plus ivermectin, an anti-parasitic oral tablet treatment – all of which she tried. GPs tend not to prescribe ivermectin first, because, although it is easier to use, it is not considered more effective, and it is expensive. This was when Louise bought “the cheapest” essentials and booked the caravan (“we have over £1,000 on the credit card”), telling only a trusted few people. Her sister had to do a mercy dash with plastic ponchos when they realised they’d forgotten coats.
Amanda Rushton, 55, who lives in north-west England, recounts a longer battle. Her family fought scabies for about 10 months, from October 2024 until last August. She still sounds weary. She first developed it after providing care for her late mother, who she believes caught scabies in hospital. She, her son, 13, who has Down’s syndrome, and daughter, 12, used permethrin twice, did laundry up to 10 times a day, and even bagged up sofa cushions, but her condition didn’t clear up. She finally bought another topical cream online, benzyl benzoate, which isn’t routinely prescribed by UK GPs.
Symptoms kept reappearing, and by last June they also appeared on her son. “He was scratching all the time, he couldn’t sleep, his sheets were full of blood. He was crying every time I put the cream on,” she says. “It actually destroys you because you’re constantly checking your skin and then having to do all the washing … I wouldn’t let anyone come into my house.”
Experts are grappling for reasons for scabies’ growing prevalence. One possible factor is that there were shortages of permethrin and malathion two years ago, due to supply chain issues. Dr Donald Grant, a GP who practises in a Welsh NHS surgery and privately as a senior clinician at The Independent Pharmacy, believes there could still be a knock-on effect. After the pandemic, people started mixing again, which, he says, “could have influenced a rise in scabies, made worse by the frequent stock issues surrounding important treatments, leading to a potential ‘ping-pong’ effect where individuals are continuously reinfested within households or close groups of friends”.
However, Michael Marks, Professor of Medicine at the London School of Hygiene & Tropical Medicine and the former chair of the International Alliance for the Control of Scabies, stresses that “the reasons for the ongoing rise … are unclear.” He says “similar trends” are being seen across Europe and that likely reasons include “outbreaks in crowded settings such as halls of residence and hostels”.
These are perhaps exacerbated by “delays in people being able to access care, and inadequate tracing and treatment of their contacts”. He says the strain on NHS GP waiting lists, leading to delayed treatment, lack of guidance and redirection to pharmacies, may also contribute to the problem. “Probably all of this plays a role,” he says. Some social media posts report frustration at initial misdiagnoses, often of dermatitis or eczema. One woman says her daughter “was tortured” with symptoms for a year before she received the correct treatment.
There has been talk of the mites becoming resistant to permethrin, although Marks says trials still find it to be highly effective if used properly. “There have been a small number of more plausible reports that there is some possible resistance,” he says. “But most treatment failure is likely to be due to ‘pseudo-resistance’: this means it fails not because of the product itself, but because it is so difficult to actually apply cream on your whole body and keep it on for 12 hours, and because, most of the time, we aren’t successful at finding and treating all (our) contacts.”
Young people, who are more likely to live in communal settings, appear to be affected the most. The UK Health Security Agency report found 41% of scabies diagnoses in sexual health services in 2024 were in people aged 20 to 24. John (not his real name), in London, is one of them. The 20-year-old, who works in hospitality, lives with his family, but it was after he began seeing a new partner in late October that he started showing symptoms. He later learned her house had recently suffered a scabies outbreak.
Dr Lea Solman, consultant paediatric dermatologist at Great Ormond Street hospital, flags embarrassment as one of the key hurdles she encounters. “The shame around scabies is one of the biggest obstacles we face in controlling outbreaks,” she says. “It stops people seeking help quickly, and it stops them having the difficult conversations needed to ensure everyone gets treated at the same time.” Solman sees the same stumbling block in parents of babies, who are particularly vulnerable. “Parents often feel deeply ashamed when their baby has scabies and that shame intensifies when they inevitably catch it themselves.”
John’s distress is clear. Itching interrupts his sleep; he wakes in blood-stained sheets. “I’m going to have quite significant scarring from this as well,” he says. “My sleep has taken such a blow and I’m going a bit loopy.” He knows 10 young people who have had scabies, but says it has become too much of a joke within student circles. “It doesn’t quite do justice to how much it affects you: this has taken a really big toll on my mental health and self-esteem,” he says.
Professor Tess McPherson of the British Association of Dermatologists says freshers’ week has become a peak transmission time. She knows patients who have left university because they can’t cope, some trying treatment up to 10 times. As John says: “No one, as a student living on their maintenance loan, has the money to be washing their clothes every single day, or to buy a steamer. I’m lucky I still live at home.”
“We’re never going to completely eliminate scabies,” says McPherson. But scrupulous treatment should be taken seriously. “You can get infections in the skin from all the scratching,” she says. “In rare cases that can lead to renal disease.”
In Kingston-Upon-Thames, south-west London, Dr Lewis Haddow, consultant in HIV and sexual health at Kingston Hospital NHS foundation trust, is “seeing scabies all the time.” The majority of patients are young, heterosexual men, which he can’t explain. Scabies is not an STI, but, as with John’s case, patients often show up at STI clinics when their GPs’ insecticidal prescriptions don’t appear to be working. “Sometimes their GPs have specifically recommended they contact us.” The fact that medics often don’t see scabies as their area may be part of the problem, he believes. “Nobody really owns it,” he says.
There is certainly a wretched sense of going it alone among sufferers. “I had been researching and researching. I’d been on the scabies Facebook page near enough daily because I was just desperate,” Louise says. Now, she just hopes she will not have to go through it all over again.
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