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 has been permethrin, which is applied over the whole body, left for 12 hours and reapplied a week later to kill remaining eggs. But mounting evidence suggests scabies have built resistance to the drug, making the cream all but useless.
Experts warn that GPs are often unaware of this – and do not know that ivermectin, which still works, was approved as an NHS treatment in 2023.
Researchers are calling on doctors to follow NHS guidance and prescribe the drug to prevent the needless suffering of thousands.
‘Undoubtedly it would be better for patients if we were prescribing more ivermectin for scabies sufferers,’ says Professor Michael Marks, an infectious disease expert at the London School of Hygiene and Infectious Medicine and chair of the International Alliance For The Control Of Scabies.
‘The research has shown that it is incredibly effective, so we need to make sure pharmacies have stock and GPs are willing to prescribe it, because patients are currently being let down. We have the tools to treat scabies, so we need to start using them.’
Mites reproduce and evolve far quicker than humans. This means the more these organisms come into contact with a drug, the more likely it is that resistance will emerge.
Doctors have claimed that, in reality, it is ‘pseudo resistance’, as many do not follow guidance on how to apply permethrin, so think it doesn’t work.
But a 2024 review published in the Journal of Clinical Medicine concluded that ‘permethrin-resistant scabies is an escalating threat’.
Social media forums are also awash with reports of untreatable cases – with sufferers resorting to natural remedies, including coating the body with coconut oil, that do not work.
Dr Tess McPherson, of the British Association of Dermatologists, says: ‘We are seeing a rise not just in scabies but in difficult to treat scabies. We are now seeing patients that are having multiple courses of permethrin and, although application is sometimes a factor as they are not leaving it on for the full 12 hours, in others we are definitely seeing this as a result of resistance.’
Ivermectin, an anti-parasitic medicine, became infamous during the Covid pandemic following claims by fringe medics that it might be a suitable treatment, and an alternative to vaccination, despite a lack of credible evidence.
The drug is routinely used in veterinary medicine, which is why it was sometimes referred to as ‘a horse de-wormer’.
It is also routinely given to children and adults in mainland Europe and beyond to treat or prevent serious parasitic infections, including scabies. Patients have to take five tablets with food and then a second dose is given a week later to kill any hatched mites.
The treatment can kill the bug and its eggs, and may stop them returning for up to two years, studies have found.
Trials have shown, in a small number of cases, patients may suffer from side effects such as dizziness and a rash similar to the infection.
But Professor Marks says the negative press and discredited research during the pandemic is partly to blame for GPs’ unwillingness to prescribe ‘what is an incredibly safe and effective drug for scabies’.
NHS guidance instructs GPs to consider offering scabies patients ivermectin as well as permethrin. They can also be used together to boost effectiveness, it states. But patients speaking to the MoS say they have had to battle for months for the pills.
Courtney Loveland, 25, was repeatedly dismissed by doctors leaving her with an agonising rash ‘in every crevice’, from between her fingers and toes to in her buttocks, that caused sleepless nights.
The care home worker from Southampton says the itch ‘was unbearable’ and left her covered in blood after nights of scratching. At first, her GP failed to diagnose Courtney with scabies, instead telling her the cause of the rash was likely her washing powder or even an allergic reaction to her dog.
‘It was really starting to affect my mental health, and I was struggling to get through the day because of how little sleep I was getting. It even hurt putting clothes on,’ says Courtney. ‘But I still couldn’t get anyone to take me seriously.’
Eventually a specialist diagnosed her with scabies.
But that wasn’t the end, as she was given permethrin and the scabs persisted. After going back and forth with her GP for six months, Courtney was finally prescribed ivermectin.
‘It should not have taken so long to be treated,’ she says. ‘It really affected me and
my GP could have stopped it.’
GPs admit that, despite the change to NHS guidelines, they are reluctant to prescribe ivermectin.
‘We tend to use permethrin or malathion, and that just comes down to our experience,’ says Dean Eggitt, a Doncaster-based GP.
‘Although ivermectin is a potential treatment, it is not one we would use regularly, so we would normally do this through a dermatologist.
‘In NHS terms, the change is astonishingly new and it will take around five years or so for this to filter down into all practices.’
Researchers say this hesitance to prescribe the drug is unsurprising. ‘Scabies is relatively common but a GP may still only see one or two cases a year and, as a result, doctors and pharmacies have not caught up with the change in guidance,’ says Professor Marks. ‘This is definitely a problem as it needs to be used more often.’
As well as prescribing ivermectin more, Dr McPherson warns that the key to battling the rise in infections is fighting the stigma associated with scabies. Many wrongly assume the infection is solely sexually transmitted or due to poor hygiene. As a result, they fail to get help, she says.
Anyone who thinks they may have scabies should visit their GP or pharmacist, who may be able to diagnose it just by examining the skin.
‘The key is making sure everyone in the household
is treated at the same time, even if they aren’t showing symptoms, to stop the spread,’ says Dr McPherson.
- Have you been affected by a scabies infestation? Write to us at health@mailonsunday.co.uk
