Experts have urged Ministers to buy stocks of the controversial horse deworming tablet ivermectin to halt a ‘nightmare’ outbreak of scabies engulfing the UK.
Worries over the disease come amid warnings that people are struggling to access standard treatments, which leading doctors claim is ‘undoubtedly’ driving infections.
Scabies is caused by tiny mites which burrow into the skin, triggering intense itching, a raised rash and crusted or scabbed skin. The condition is spread by close skin contact with others, so often affects whole households, as well as residents of care homes, and it can also been passed on during sex.
Ivermectin, an anti-parasitic, is used in veterinary medicine – which is why it is commonly referred to as a horse dewormer – but it is also routinely given to children and adults in mainland Europe and beyond to treat or prevent a wide range of serious parasitic infections, including scabies.
Unlike the standard treatments for scabies used in the UK – skin lotions called permethrin and malathion – ivermectin comes as a pill and is given in two doses a week apart.
Scabies is caused by tiny mites which burrow into the skin, triggering intense itching, a raised rash and crusted or scabbed skin
Unlike the standard treatments for scabies used in the UK – skin lotions called permethrin and malathion – ivermectin comes as a pill and is given in two doses a week apart
The treatment can kill the bug and its eggs and may stop them returning for up to two years, studies have suggested.
The drug became infamous during the Covid pandemic following claims by fringe medics that it might be a suitable treatment, and even an alternative to vaccination, despite a lack of credible evidence.
The Mail on Sunday first reported that skin specialists were calling on Ministers to approve ivermectin as a first-line scabies treatment last summer, and the green light was given in September.
GPs can now prescribe it and pharmacists are permitted to sell it over-the-counter.
While supply-chain problems linked to the war in Ukraine and increased costs of raw materials have resulted in shortages of permethrin and malathion, no such problems are believed to be affecting ivermectin.
Dr Tess McPherson, of the British Association of Dermatologists (BAD), says: ‘The current outbreak of scabies was predicted last year, and in light of this ivermectin was licensed as a first-line treatment.
But the Government has failed to buy in enough stocks, and many GPs and pharmacists remain unaware it’s even an option. It needs to urgently address this issue and make sure there are adequate supplies not just of ivermectin, but the topical creams, too. Otherwise we will have a far bigger outbreak of scabies.’
Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, backs the calls: ‘We’ve seen a surge of scabies recently because care homes have been affected, so demand for permethrin and malathion went up and supply became patchy.
Ivermectin is most commonly used as a horse dewormer, but some experts believe it could combat scabies
‘Pharmacists welcome anything that would help support patients with their symptoms rather than making them wait. If it’s safe, why not make it available?’
Scabies is highly infectious and, if not properly treated, it can linger for months or even years. The parasite and its eggs can also live in bedsheets and towels, which can pass the infection to others.
Diagnosing it can be tricky because the tell-tale red rash – which affects the skin folds inside the elbow, knee, buttocks and between fingers and toes – can take eight weeks to appear. It can also spread across the body and might include ‘trails’ – lines under the skin where the mites have burrowed to lay eggs.
Scratching the marks can exacerbate other skin conditions such as eczema or psoriasis, too, and may lead to bacterial infections. But it is a myth that scabies is linked to poor hygiene.
It most commonly affects younger people due to the way it is transmitted – some of whom pick it up through sexual transmission – and the elderly in care homes.
Those with weaker immune systems may be vulnerable to crusted scabies, a more severe form of the disease which involves a higher density of mites.
Scabies can often be passed on by close physical contact – especially when intimacy is involved
Treating it generally involves rubbing an anti-parasite lotion all over the body, including under the nails, and keeping it on for between eight and 12 hours, re-applying it every time you wash your hands. The process must be repeated seven days later to ensure all mites and their eggs have been destroyed.
Everyone in the same household, and any sexual partners over the last eight weeks, must also apply it, even if they don’t have symptoms due to the time they take to appear.
Despite suggestions that the latest outbreaks were being driven by people becoming resistant to the treatments, there is no evidence, says Dr McPherson. The more likely explanation is that people are not applying the cream properly or for long enough.
It means ivermectin, which is easier to use, is an important alternative and may be particularly helpful to control outbreaks in care homes, for instance.
‘For a lot of my young patients, the solution seems to be using the creams and taking ivermectin on top,’ she adds. ‘So we need access to all of the medication that’s available to get on top of the infections.’
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. They can also prescribe ivermectin or an anti-parasitic cream.
If they can’t be sure, they may refer you to a dermatologist who can run tests to confirm the diagnosis before prescribing a treatment.
Other ways to stop it spreading or returning in the home include washing clothes, bedsheets and towels at temperatures above 50C.
Jo Middleton, an expert on scabies from Brighton and Sussex Medical School, says: ‘Introducing ivermectin to the UK means people could control their scabies infestation more easily. But it’s a question of supply. Hopefully the one positive that will come out of the surge of cases is the routine adoption of oral ivermectin for managing scabies outbreaks.’
The Department for Health and Social Care failed to comment.
