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AN INCREASE IN scabies has been noted in Ireland and across multiple countries in recent decades. A nine-fold increase in cases occurred in Germany from 2009 to 2018 while the number of cases tripled in the Netherlands between 2011 and 2021. Norway noted an almost three-fold increase in scabies consultations and prescriptions between 2013 and 2018.
Last year the UK Royal College of General Practitioners reported a significant rise in GP consultations for scabies in England with weekly notifications well above the five-year average.
Similar trends are now being seen in Ireland. In 2024, there were 51 scabies outbreaks in Ireland, almost twice the number notified in 2023 (26), compared to nine in 2022 and four in 2021, according to figures from the Health Protection Surveillance Centre (HPSC).
Outbreaks in Ireland occurred across a variety of settings. In 2024, the highest number of outbreaks occurred in nursing homes (23), accounting for almost half (45%) of all outbreaks notified. The numbers affected in each outbreak ranged from two to 18.
This compares to a total of ten nursing home outbreaks in 2023 and four in 2022.
Scabies outbreaks were also notified in private households/ extended families (9); other residential institutions (7); hospitals (2); and community hospital/ long-stay units (1).
Of the seven outbreaks reported in residential institutions in 2024, two occurred in centres for disabilities, two in centres for older people, one in a centre for refugees / direct provision centre, one in a homeless facility and one in another residential institution location.
Nine outbreaks were notified in other settings including schools, childcare facilities and other healthcare services.
Scabies is a very common itchy skin condition caused by a tiny mite. They bore into the human skin and make a home there. Anyone of any age can get scabies – contrary to popular belief, it is not caused by poor hygiene. Scabies can easily spread from person to person through skin-to-skin contact, including sexual contact.
Once infected, it can take three to six weeks for symptoms to occur and can spread to others during that time. The usual infection, ‘classical scabies’ presents with an itchy skin rash, caused by an allergy to the scabies mite.
Less commonly, a type of scabies known as crusted scabies can occur, due to an increased number of mites in the skin. Crusted scabies is highly contagious and is more likely to affect elderly people or individuals with a poor immune system or mobility issues.
Symptoms include itching which can affect the whole body and can be worse at night or after having a bath. A rash is typically seen in affected areas, including in skin folds, for example between fingers and toes.
Scabies mites pass easily from one person to another when there is close personal contact, such as groups of people living in family homes, residential or nursing homes. It can also be transmitted during sexual contact. Healthcare professionals, particularly nurses and carers providing close personal care, may catch scabies from infected patients.
Transmission usually requires skin-to-skin contact for about five to 10 minutes or longer. Shaking hands with someone is unlikely to involve sufficient contact with the skin to allow infection to be transmitted.
So what is going on? Why are the number of cases of scabies rising so precipitously in the last two decades? The HPSC reports that the reasons are likely to be multifactorial.
‘Possible factors include travel and migration of people from areas of high incidence, people living in close quarters e.g. residential care facilities and overcrowded congregate settings, in addition to delayed diagnosis and treatment.’
The HPSC reports that the notable increased incidence in adolescents and young adults in a number of countries may be explained by the increased social connectivity generally seen in this age-group, potential sexual transmission, along with possible reduced compliance with treatment.
Added to all that, since the notable upsurge in scabies outbreaks began in 2023, Ireland has experienced treatment supply shortages of medications to treat scabies, with similar issues reported in the UK.
Permethrin 5% cream is currently recommended as first line treatment, with Malathion 0.5% liquid advised as second line treatment. In response to recent supply shortages, the HSE has updated treatment guidance to include benzyl benzoate 25% w/v as a third line option. Oral ivermectin is only indicated in cases of treatment resistant scabies and on specific microbiological or dermatological advice.
Scabies is not usually a serious condition, but it does require careful management to ensure effective treatment. This includes treatment with skin creams and the killing of any mites that may be lodged in clothes, bedding or other personal items to both cure it and prevent any further spread.
If you think you have scabies, talk to your GP or pharmacist, who can provide you with skin creams and support with additional measures to treat and clear the infection.
Normal washing or showering with disinfectant neither treats nor prevents scabies. When applying skin creams, it is important that the prescribed cream is applied according to the manufacturer’s instructions and is left on for the recommended level of time. A second treatment is required a week later to complete the treatment.
Following the first treatment, all clothing, bedding, throws and towels should be washed in a minimum 50C wash cycle or put in a tumble dryer for 30 minutes at a minimum of 50C to destroy mites.
Alternatively, items such as shoes, coats, hats, toys, covers for car seats or buggies can be sealed tightly in a plastic bag for four days. This will destroy mites. Other items such as mattresses, couches and car seats that have had prolonged skin contact can be vacuumed.
If you have scabies, it is really important that all household contacts you have personal contact with, and sexual contacts are informed and follow the same advice on treatment and management of clothes and bedding at the same time.
Any delay can mean that household contacts who are incubating infection can present with symptoms at a later date and make clearance of the household more difficult.
Anyone who requires treatment should be treated at the same time as you.
Children can return to school and adults to college or work 24 hours after the first application of the cream.
Itching may continue following treatment, as this is an allergic response to the mite and is not necessarily evidence of active infection. Your GP or pharmacist can advise you on treatments to relieve itching. If there is no improvement after four weeks, following the correct application of treatment and completion of other control measures, seek further medical advice.
Previous infection with scabies does not confer immunity, so yes, you can become infected again. With repeat infection, the rash may appear much quicker, from 1-4 days after being re-infected.
Scabies is a common itchy condition that spreads easily from person to person through close person-to-person skin contact. Proper management requires care with skin cream applied correctly, as well as clothes, bedding and soft furnishings that were in contact with skin, dealt with at the same time as treatment.
To prevent reinfection, all household contacts should be offered treatment and their clothes and bedding managed appropriately at the same time as the case.
Dr Catherine Conlon is a public health doctor in Cork.
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