Doctor shares symptoms to look out for amid scabies outbreak

According to NHS figures, 3,689 cases of scabies were diagnosed in hospitals in England this year to April. This is up from 2,128 from the previous year.

The Express spoke to Dr Deborah Lee from Dr Fox Pharmacy, a fully regulated UK online doctor and pharmacy service managed by NHS GPs.

Dr Lee has shared some of the health symptoms people should be looking out for and where it is most commonly found on the body.

She also shared some of the reasons of what could be behind the outbreak in the UK and if it is contagious.

But first what exactly is scabies and what do they look like?

What exactly is scabies?

Scabies is an infestation of the skin by the scabies mite Sarcoptes scabiei. The mites are tiny with an adult mite measuring between 0.3-0.35 mm in length.

The mites are transmitted by prolonged periods of close, skin-to-skin contact. They tunnel under the skin leaving a scaly track to create a burrow. Here, the females lay their eggs, which hatch in three to four days. The baby mites mature into adults in one to two weeks. A person can develop an allergic reaction to the presence of the mite and its dung, which causes an intense, itchy skin rash.

What symptoms should people look out for?

The most commonly affected parts of the body are the webs between fingers and toes, the wrists, under the arms, the umbilical area, the groin and the buttocks. It can also affect the head and neck, the palms and soles, the genitalia and under the breasts.

The scabies rash consists of little raised red spots that are intensely itchy. A person might be able to see the linear appearance of a burrow with a black dot at the end. The skin around the area becomes red and inflamed and it may become scaly. Some individuals might see blisters and pustules.

These spots are incredibly itchy, especially at night. The itch of scabies can also last for weeks after treatment.

Scabies can result in secondary bacterial infection of the skin lesions, leading to impetigo, skin abscesses and septicaemia. This can also cause rheumatic heart disease and kidney disease.

What is causing the outbreak?

The British Association of Dermatologists (BAD) are worried about a recent increase in the number of cases of scabies in the UK. 3,689 cases were reported in the UK up to April 2024, which had increased from 2,128 the previous year. This could be for a variety of reasons.

There have been particular outbreaks in Care Homes and Nursing Homes and in those living in university accommodation. Also, the most effective scabies treatments, permethrin and malathion, are now difficult to obtain due to supply chain issues related to the war in Ukraine.

Scabies infestations are also more common anyway in the winter when we all spend more time indoors and close to others.

Many people feel too ashamed to go for help as there is still considerable stigma with having it. This has been badged as ‘a Public Health emergency’ as scabies spreads quickly and outbreaks can be difficult to contain.

Scabies can affect anyone but are often seen in babies, small children and the elderly. It is also more common in those living in overcrowded environments and the immunocompromised.

Scabies are not caused by being unclean. There should be no stigma in having scabies. It can be transmitted during sex as there is a lot of skin-to-skin contact, but it is not a sexually transmitted disease. The majority of scabies sufferers will not have become infected in this way.

A specific type of scabies called Norwegian crusted scabies is more common in immunocompromised patients with HIV. Scabies can be difficult to diagnose as it has similar features to eczema, psoriasis, urticaria, folliculitis and other blistering skin conditions. Another similar skin rash on the palms and soles is the rash of secondary syphilis. It is more difficult also with black or brown skin.

Is it contagious?

Scabies is contagious as it is passed from one person to another by close skin-to-skin contact. However, the skin needs to be in contact with another person’s skin for at least 20 minutes for it to be transmitted. A person cannot get scabies just by shaking someone’s hand or hugging. It is spread if you sleep in the same bed or cuddle up for long periods with a person who has it.

The mite can survive for 36-48 hours outside the body so could in theory be passed on via infected bed sheets or towels but in practice, it is thought to be very rare for it to be passed on like this.

How can the risk of catching scabies be reduced?

Someone can avoid getting scabies by avoiding having close skin-to-skin contact with anyone who has it. Also, avoid sharing bedding and towels.

The key thing about scabies is that if a person is diagnosed with scabies, all contacts should be treated. This means anyone who lives in the same household, or any other regular contacts such as members of a football team, or close friends or family that visit regularly, must be treated. They need to be treated at the same time and repeat the treatment seven days later.

The pharmacist will recommend a cream or a lotion that is applied to the whole body. This must be done carefully with specific attention to the body folds such as the finger and toe webs, the axillary areas and under the breasts. There is specific advice for children aged two and under. Also, any sexual partners in the past eight weeks should also be treated. The lotion or cream should be left to dry on the skin for 10-15 minutes before getting dressed again and should be left in contact with the skin for at least 12 hours before washing it off.

All bedding, towels and clothing should be washed at 60C. Any clothing that cannot be washed should be put in a plastic bag and left for three days to give time for the mites to die.

Adults and children aged five and over can go back to work or school immediately after being treated. However, under five-year-olds should stay away from school or nursery for 24 hours.

Individuals should not have close physical contact or sex until they have completed the full course of treatment and this needs to be repeated after seven days.

If these instructions are not followed carefully, mites can survive, and eggs can continue to hatch meaning it’s impossible to get rid of the infestation.

When treating scabies in institutions, oral anti-scabies treatment with ivermectin is often preferred.

Do not use alternative or natural remedies for scabies. They will not kill the scabies mite. Only use recommended treatments from your pharmacist or GP.