In recent months, Naveed Ijaz, a general practitioner specializing in dermatology, has seen a growing number of patients presenting at his clinic in Manchester, UK, with intensely itchy rashes. Their cause is scabies, a highly contagious skin condition caused by the Sarcoptes scabiei mite, which can result in these itchy rashes spreading all across the body.
“I am extremely concerned, chiefly because of the shortage of treatments available,” says Ijaz. “Outbreaks tend to occur more so over the winter months, as people tend to spend more time together indoors. The shortage of available treatments compounds this.”
While scabies is extremely common, affecting approximately 200 million people worldwide, cases across England are spiking far above typical levels. Reports have detailed outbreaks in care homes and university accommodations, particularly in the north of the country.
Kamila Hawthorne, chair of the UK’s Royal College of GPs, told WIRED that weekly incidences per 100,000 for the north of England continue to be well above the national and five-year average. Their most recent surveillance reports detailed 1,926 cases across the country between early December and January.
The UK’s surge of cases is part of a wider, longer trend. Scabies cases have been rising consistently across Europe and around the globe for a decade. Unlike other infectious diseases, this isn’t thought to be a consequence of climate change, but a cocktail of factors—treatment shortages, treatment failure, and the persistent stigma surrounding the disease that prevents some from immediately seeking medical attention.
Until the condition is treated, scabies mites can reproduce, burrow, and lay eggs under the skin, causing sores and cycles of itching to continue. The mites can easily be transmitted to others, particularly through skin-to-skin contact—during sex, for example. Ijaz says he has seen several cases where individuals were infected by a sexual partner, while some of the data on the extent of the current UK outbreak has come from sexual health clinics.
“The mites can crawl off the human being and onto sofas or bedding, which is partly how outbreaks can be sustained,” explains Michael Head, a senior research fellow in global health at the University of Southampton in the UK. “It’s quite common in schools, prisons, and care homes, and we’ll sometimes see outbreaks in hospital wards or hostels. The mite is relatively common, quite hardy, and alas for us, very good at doing its own job.”
The two main treatments for scabies are permethrin and malathion, skin lotions that need to be rubbed across an infected person’s body to kill all the reservoirs of mites and eggs. Traditionally these treatments have been highly effective, but in recent years there have been growing reports of treatments failing. A recent review of research on the topic, published by the British Journal of Dermatology, states that the treatment failure rate can be as high as 30 percent. The review notes that drug resistance among mites is an emerging concern, but also concedes that relatively little is known about this threat.