Doctors are reporting a rise in scabies cases in Britain amid an acute shortage of treatments, saying the “nightmare” situation poses a major threat to public health.
Scabies is a highly contagious condition caused by mites that results in an itchy rash. It is spread by close contact with the skin. Anyone can get it and it needs to be treated quickly to prevent its spread.
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 commodity prices has led to months of shortages of both.
It has led to an emerging public health crisis, with dermatologists and GPs struggling to treat people with scabies quickly, the Guardian has been told, with the north of England seeing double the number of normal cases in November.
Medics are reporting the increase because they fear that the inability to quickly treat those affected is allowing 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 research into patients with scabies was “very limited”, a dermatologist leader said, suggesting the problem could be worse than feared.
Some patients have become so desperate that they have tried to buy hugely expensive alternative treatments on the internet from outside Britain.
Prof. Mabs Chowdhury, chairman 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 complicated: scabies spreads easily and if people are not treated, the disease will continue to spread. Unfortunately, the consequences of treatment shortages prove easy to ignore. The number of cases of scabies is very limited and people are often ashamed to talk about it.
“A major problem is the spread of scabies in care homes, student homes and other communal living facilities. This makes treatment much more difficult. If even one person is not fully treated, anyone can become reinfected. Given the challenges in social care and treatment shortages, public health authorities must plan for outbreaks in healthcare settings.”
A British Association of Dermatologists survey commissioned by the Guardian found that eight out of nine regional representatives had reported an increase in scabies in their areas this year. Seven of the nine reported permethrin and malathion deficiencies.
A dermatologist in the Northeast said the shortages were creating a vicious cycle. “The lack of availability is likely to lead to greater spread of infection, again requiring further scabetic treatment and increasing pressure on demand.”
Chowdhury said cases were likely to rise further as people spent more time together indoors during the winter months. “Meanwhile, the shortage of treatments is putting enormous pressure on people with scabies, some of whom have resorted to buying treatments online at high prices,” he added.
Prof. Kamila Hawthorne, president of the Royal College of GPs, said that while scabies itself is not a serious condition, it can be very irritating and if not treated properly it can spread and increase the risk of infections or existing can worsen conditions such as eczema. .
“It can also affect a patient's quality of life, so prompt treatment is important,” she said. “Since July, GPs have seen an increasing number of scabies cases – at consistently higher levels than the five-year average and seasonal norm. This was particularly evident in the north of England. At the end of November, the rate of scabies was three cases per 100,000 inhabitants, which is double the seasonal average.”
She added: “The treatment for scabies is a topical cream or lotion that can be bought from a pharmacy, or with a prescription from a GP practice. However, there have been reports of shortages of the two most commonly used medications, permethrin cream and malathion lotion. When prescribed medicines are unavailable or in short supply, this is worrying for general practitioners, pharmacists and patients.
“GPs and pharmacists are already under enormous pressure to provide care to their patients during the peak season, and any drug shortages, even temporary, will worsen the situation.”
Dr. Tess McPherson, president of the British Society for Pediatric and Adolescent Dermatology, said it was crucial to emphasize that people do not get scabies because they are unhygienic. “We need to reduce any stigma associated with scabies so that people seek treatment when necessary.”
Anyone can get the condition, she said. Including, it turns out, her son, a student at Cambridge University. “I was a little surprised when I diagnosed my own son, but perhaps not so surprised as I now see much more common cases of scabies in children and young people.”