Outbreak of medieval disease could wreak havoc on schools and care homes
Skin-eating scabies mites are on the rise across the UK, threatening entire schools and care homes, a leading expert on the disease told Metro.
Dr Jo Middleton said there has been a ‘substantial increase’ in scabies outbreaks in schools, creating the risk of long-term health problems for young people.
The condition, which is triggered by tiny mites that burrow and lay eggs under the skin, has even contributed to the deaths of some elderly people, he added.
Metro spoke to the Senior Research Fellow at Brighton and Sussex Medical School about the chaos the Victorian disease can cause and why it’s suddenly running rampant.
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Schools wiped out by rise in scabies
It is hard to track exactly how many people have the itchy mites, in part because doctors are not obliged to report cases to the government.
Dr Middleton, who specialises in controlling scabies outbreaks, said at least 250 schools, prisons, care homes and hospital battle the issue every year in England and Wales.
But now the problem is getting worse.
Dr Middleton explained: ‘We are seeing outbreaks in institutions constantly.
‘Scabies has been a real problem in the last few years.
‘Anybody can get scabies, that is why it is so contagious. You just need to be touched by somebody.’
What is Scabies?
Scabies is an itchy rash caused by mites which burrow into the skin.
The Victorian-associated disease is spread through close skin contact.
Symptoms include intense itching and red looking spots all other the body except the head and neck (although older people may get a rash in those spots as well).
The tiny red spots are caused as mites lay eggs within the skin, which then spread around legs, arms and other body parts.
It does require treatment, usually in the form of cream or lotion.
Patients with other skin conditions such as eczema, or who have symptoms for more than two to four weeks despite treatment, should seek the help of a GP.
Scabies spreads through close skin contact, including sexual contact. You cannot get scabies from pets.
People who live or work closely together in nurseries, university halls of residence or nursing homes are more at risk.
Source: NHS
The importance of physical touch in transmission is also why the number of young people presenting with the mites at sexual health clinics is also skyrocketing.
According to the professor, the UK Health Security Agency is seeing a ‘substantial increase’ in call-outs to tackle outbreaks in schools.
He said he advised one large school which had cases across seven different classes.
One reason schools are so vulnerable is because it takes four to six weeks for signs of the conditions to show, but you can be infectious from as early as two weeks in.
‘It’s always catch up,’ he said, ‘by the time that individuals are starting to scratch and itch, you can guarantee other people have become infected in a school and family.
‘These things transmit unpredictably. Friends are in different classes, family members in different year groups.
‘It causes massive logistical problems, sleeping problems and stigma which interfere with learning.’
In November, a number of cases of scabies were reported at schools in Devon.
The only way to stop the mites in their tracks was to screen entire classes of children, physically examining them for signs of scabies.
Anyone with signs of burrows – and their immediate contacts – were treated, with the whole screening process taking two months.
Similar outbreaks in care homes can also cause huge problems for patients and staff.
Dr Middleton said: ‘Everyone has to be treated and on the same day. A whole care home have to all be stripped, covered in cream and that cream left on for 6-8 hours.
‘At the same time their bedding and clothes needs to be washed. And that needs to be repeated several days later.’
‘Repeat infections can lead to long-term health problems’
Scabies is primarily an ‘irritant problem that reduces quality of life’ – but it can be far more serious than that too.
If young people in schools are repeatedly infected with the burrowing mites, there is good evidence they might develop further health complications later in life, Dr Middleton told Metro.
He explained that the intense itching caused by scabies can lead to constant scratching, which creates open wounds on the skin.
He continued: ‘Because the scabies mite has inhibited your immune response, the wounds can become infected.
‘If you get multiple cases of impetigo then that definitely is associated with a number of later serious health problems.’
In elderly people, scabies can cause life-threatening complications.
That’s due to a rare phenomenon called crusted scabies.
In normal scabies, someone might have up to 20 female mites in their skin, but in crusted scabies, someone could be infested with tens of thousands.
‘We have had elderly people who have died with scabies as a contributing factor, because they’ve had crusted scabies,’ Dr Middleton warned.
‘There is no difference in the parasite – it is a difference in the host. The patient is elderly and their immune system is low.’
New treatment brings hope after shortfall in creams
Scabies has traditionally been treated with a cream called permethrin, followed up by another cream called malathion if that doesn’t work.
However, there have been supply chain issues with the drug since Brexit, which has been one of the key factors in the current spike in cases.
Dr Middleton said: ‘If you have a supply line problem for a year and a half, that means there are more cases out in the population – each of which can cause a new outbreak.’
A lot of people don’t use the creams well either – it needs to cover the whole body and should be reapplied if washed off.
There is reason to be optimistic; there is a new treatment available called ivermectin.
The anti-parasitic oral tablet was approved for use on the NHS in 2024, in part due to studies carried out by Dr Middleton and his team.
The drug – primarily used to treat large outbreaks but not individual cases – is finally making treatment much easier.
Dr Middleton said: ‘There is a positive message, which is that we have the medicines to treat this, so we can stop outbreaks from getting really bad and stop transmissions happening out in the general population.’
Heading into 2026, the expert hopes awareness of scabies continues to grow, so future outbreaks can be contained before they get out of control.
What has the UK Health Security Agency said?
A UKHSA spokesperson said: ‘We have seen an increase in scabies diagnoses at sexual health services between 2023 and 2024.
‘Scabies is a skin condition caused by tiny mites that burrow into the skin. The symptoms include severe itching and often a rash, most commonly seen on the hands, but blisters can appear on other parts of the body.
‘Symptoms can take up to 6 weeks to develop, during which time the infection can be spread to others.
‘Scabies spreads through close skin contact and anyone can get it – it is not caused by poor hygiene.
‘It is not usually serious but needs treatment as soon as possible because it is very infectious.
‘If you have scabies, take steps to stop it spreading during treatment, including washing all bedding and clothing worn in the week before or any time up to 24hrs from starting the treatment at the hottest cycle the fabric tolerates on the first day of treatment and putting clothing that cannot be washed in a sealed bag for 4 days until the mites die.
‘Do not share bedding, clothing or towels with someone with scabies and avoid close physical contact including sex until you have completed the full course of treatment.’
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