Scabies is making a comeback


In recent months, Naved Ijaz, a general practitioner specializing in dermatology, has seen an increase in the number of patients with intensely itchy rashes at his clinic in Manchester, UK. Their cause is scabies, which is a highly contagious skin condition. sarcoptes scabiei Mites, resulting in these itchy rashes, can spread throughout the body.

“I am extremely concerned, mainly because of the lack of treatments available,” says Ijaz. “Outbreaks are higher in the winter months, as people spend more time together indoors. “The lack of available treatments further exacerbates this.”

While scabies is extremely common, affecting around 200 million people worldwide, cases across England are rising far above normal levels. Reports have detailed outbreaks in care homes and university residences, particularly in the north of the country.

Camilla Hawthorne, president of the UK's Royal College of GPs, told WIRED that weekly incidence per 100,000 in the north of England remains well above the national and five-year average. Their most recent surveillance report details 1,926 cases across the country between early December and January.

The rise in cases in the UK is part of a wider, longer trend. The incidence of scabies has been rising steadily across Europe and the world for a decade. Unlike other infectious diseases, it is not thought to be the result of climate change, but rather a combination of several factors – lack of treatment, treatment failure, and persistent stigma around the disease that prevents some people from seeking prompt medical attention.

Unless the condition is treated, scabies mites can reproduce, burrow, and lay eggs under the skin, continuing the cycle of lesions and itching. The particles can easily spread to others, especially through skin-to-skin contact – for example, during sex. Ijaz says he has seen many cases where individuals were infected through a sexual partner, while some of the data on the extent of the current outbreak in Britain has come from sexual health clinics.

“Mites can crawl from humans to sofas or beds, partially perpetuating outbreaks,” explains Michael Head, a senior research fellow in global health at the University of Southampton in the UK. “It is quite common in schools, prisons and care homes, and we will sometimes see outbreaks in hospital wards or hostels. This mite is relatively common, quite hardy, and unfortunately for us, it is very good at doing the job itself.

The two main treatments for scabies are permethrin and malathion, skin lotions that need to be rubbed into the infected person's body to kill all stores of mites and eggs. Traditionally these treatments have been highly effective, but in recent years there have been increasing reports of treatments failing. A recent review of research on this topic, published by British Journal of Dermatology, states that treatment failure rates can be as high as 30 percent. The review noted that drug resistance among mites is an emerging concern, but also acknowledged that relatively little is known about this threat.