Scabies cases are surging across the UK and Europe. The tiny mites that cause it spread easily through skin contact, making children, young adults and elderly people particularly vulnerable. Effective treatments are available, but myths and stigma are getting in the way of proper control.
What is scabies and how do people catch it?
Scabies is a skin infestation with tiny mites called Sarcoptes scabiei. The mites transfer from person to person through skin-to-skin contact – when parents cuddle children, care workers help residents, people share beds, or during sex. Occasionally, contaminated clothing or bedding can spread them too.
Are scabies cases rising in the UK, and if so why?
In institutions across England and Wales, such as care homes and schools, our team found 241 outbreaks in just one year.
In the wider population, the picture is less clear because scabies does not have to be officially reported to health authorities, and many people treat it themselves using over-the-counter medicines. However, reports from GP surgeries and sexual health clinics suggest cases have risen sharply over the last few years.
We don’t yet know all the reasons for this rise. However, one of the main culprits is that in 2023 and 2024 supply chain problems left pharmacy wholesalers struggling to stock imported scabies creams. With treatments delayed, more people became infested.
Who is most at risk of catching scabies?
Anyone can catch it, but three groups face the highest risk: children, sexually active young people and the elderly. This is mainly because these three groups tend to have more physical contact and are congregated in institutions like nurseries, universities and care homes. People in other crowded settings, such as migrant centres or prisons, are also at risk.
Is scabies caused by poor personal hygiene?
Absolutely not. Bathing habits make no difference to scabies rates. Unlike many bacteria and viruses, these mites tolerate soap and alcohol handwash just fine.
What are the symptoms?
Scabies usually causes an intense itch, particularly at night. However, these symptoms usually take around four to six weeks to arise if it is the first time someone is exposed.
Sometimes you can spot S-shaped burrows on the skin, particularly between fingers or on genital areas. In elderly patients, we’ve found scabies can look quite different – they may not even complain of itching.
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How contagious is scabies and how long can mites survive off the body?
Scabies is highly contagious. Even a few minutes of skin-to-skin contact – such as holding hands – can be enough for a mite to crawl from one person to another. This is how most people become infested. Depending on room temperature and humidity, the mites can survive off the body for up to a week, but human skin is their natural habitat.
Why does scabies treatment sometimes fail or seem not to work?
Traditional cream treatments work well in ideal circumstances, but using them correctly can be difficult. The creams need to be put over the entire body and left on for hours. At the same time, clothing and bedding need to be washed, and close contacts, such as family members, need to be treated even if they have no symptoms.
This whole process then needs to be repeated seven days later. This is because the creams work excellently at killing the adult mites, but less well at penetrating egg-cases. The second treatment will kill the newly hatched mites before they have a chance to mate. Not carrying out any of these steps risks failing to eradicate the mites.
Even successful treatment can leave itching that persists for weeks, wrongly leading people to assume they’re still infested.
Why was an oral medication recently introduced?
In many countries, an oral medication called ivermectin has been available for treating scabies for many years – making treatment far easier. To tackle the surge in cases, my colleagues and I in the NIHR Applied Research Collaboration Kent, Surrey, Sussex were involved in getting the drug licensed and available on prescription in the UK. But like the creams, it usually needs repeating after seven days to be fully effective.
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Is scabies becoming resistant to medicated cream?
There is evidence scabies mites in other countries have developed some resistance to permethrin, the medicated cream used to eradicate them. However, most treatment failures in the UK probably stem from the practical difficulties of using treatments correctly rather than the medication itself not working.
What are the emotional and mental health effects of scabies on patients and families?
The visible signs on skin, combined with the persistent myth about poor hygiene, create real problems. When we’ve spoken to patients and their families, they describe feeling ashamed, being judged by others, and withdrawing socially. Add in disrupted sleep from the itching, and the mental health impact can be serious.
Why do shame and embarrassment make scabies harder to control?
Early diagnosis and treatment reduce how many people catch it from an infected person. But shame causes delays – people put off seeking help for themselves, their family members, or even residents in their care. This gives the mites more time to spread.
What should people do if they think they have scabies?
If you are concerned about scabies, you should see your GP. They can examine your skin to determine if it is indeed scabies and put a treatment plan in place, if necessary.
Dr Jo Middleton receives funding from the National Institute for Health and Care Research (NIHR) through its Applied Research Collaboration Kent, Surrey, Sussex (NIHR200179). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
