Scabies outbreak in Spain: What is driving the massive surge in cases?

A surprising public health challenge is sweeping across Spain, catching many residents and travelers off guard. Recent data shows a dramatic spike in scabies cases nationwide, raising urgent questions about how this highly contagious skin condition spreads and who is most at risk. From bustling student housing to residential care facilities, understanding the realities of this outbreak is the first step toward prevention and effective treatment.

Scabies is a contagious skin infestation caused by the microscopic mite Sarcoptes scabiei. Let me be clear right from the onset although poor hygiene can be a root cause, scabies can affect people of all ages, social classes, and all living conditions. Scabies doesn’t care who you are, it is nothing to be ashamed of. In recent years, Spain has experienced a significant increase in scabies cases, prompting concern among public health authorities and healthcare professionals.

The rise has been particularly noticeable in nursing homes, healthcare facilities, households, and other environments including hotels and student accommodation where close physical contact is common.

What is Scabies? Symptoms and how it spreads

Scabies occurs when female mites burrow into the outer layer of the skin to lay eggs. Yes, I know it sounds horrid when you explain it in detail. The body’s immune reaction to the mites, eggs, and waste products causes really intense itching and a very characteristic rash. Symptoms typically appear between two and eight weeks after the initial infection.

Common symptoms include intense itching (especially at night), small red bumps or blisters, and thin, irregular burrow tracks on the skin. The rash commonly affects the wrists, fingers, elbows, waist, buttocks, and genital area.

Scabies spreads primarily through prolonged skin-to-skin contact. However, it can also spread through shared bedding, towels, or clothing. Because symptoms may take weeks to develop, infected individuals can unknowingly transmit the condition to others before realizing they are affected. This is what makes the public health response even more challenging.

Diagnosis and effective Scabies treatment

Diagnosis is usually based on clinical examination and patient history, although skin scrapings may also sometimes be used to identify mites or eggs under a microscope. Treatment commonly involves prescription topical medications such as permethrin cream or oral ivermectin in more extensive outbreaks. You can buy 5% permethrin cream or lotion at the pharmacy, other products will require a prescription because they are based, in part, on body weight.

Successful treatment requires treating all household members and close contacts simultaneously, alongside washing clothing, bedding, and towels at high temperatures (60°C). It is also vital to vacuum furniture and mattresses, while avoiding close physical contact until the treatment is fully completed.

Important application tip: You must apply the cream from the neck down, not just where you see a rash or have an irritation. Failure to treat all contacts at the same time is a common reason for recurring infestations, as is not following the instructions to the letter when it comes to using the lotion or cream.

The growing Scabies problem in Spain: The data

Spain has witnessed a substantial increase in scabies incidence over the last decade. A major national study examining data from 2011 to 2023 found that scabies cases have been steadily rising since 2011, with a particularly sharp acceleration after 2020. Researchers reported that primary care diagnoses increased by an average of nearly 66% annually between 2020 and 2023.

The increase is not limited to one region. Cases have been reported across the country, with particularly high incidence rates in northern coastal areas and island regions. The highest rates in primary care were observed among young adults aged 15–24 years, while hospitalization rates were highest among people over 65 years old.

Public health experts believe several factors may be contributing to the rise: increased close-contact transmission during the post-COVID period, delayed diagnosis due to lack of awareness, crowded living environments, population aging with greater numbers of residents in long-term care facilities, and possible treatment failures or emerging resistance concerns, although more research is needed to look at this.

Outbreaks in nursing homes and care facilities

One of the most striking aspects of Spain’s scabies situation is the concentration of outbreaks in nursing homes and residential care facilities. Historical surveillance data show that nursing homes have long been a major setting for scabies transmission, accounting for some of the largest outbreaks recorded in the country.

Recent studies demonstrate that outbreaks in nursing homes increased dramatically between 2020 and 2023, rising tenfold from 13 outbreaks annually to approximately 130 outbreaks. Healthcare workers and nursing assistants have become one of the highest-risk occupational groups. In Andalusia, authorities recorded 64 scabies outbreaks in nursing homes during 2024, affecting 846 residents. Similar numbers were reported during 2025, highlighting the continuing challenge.

Spain’s public health response and moving forward

Spanish health authorities have strengthened surveillance and outbreak management efforts. Current control measures include rapid diagnosis, contact tracing, simultaneous treatment of residents and staff, environmental cleaning, and ongoing monitoring of affected facilities. Public awareness campaigns have also emphasized that scabies is a medical condition rather than a reflection of personal cleanliness.

Researchers from Spain’s National Centre for Epidemiology and the Instituto de Salud Carlos III have called for enhanced surveillance systems, better education for healthcare professionals, and targeted prevention measures for high-risk populations such as nursing home residents and healthcare workers.

In conclusion

Scabies remains a significant public health issue in Spain. While the disease is generally treatable and rarely dangerous, its highly contagious nature allows it to spread rapidly in settings where people live or work closely together. Recent research shows that Spain has experienced a marked increase in scabies cases since 2011, with the most dramatic growth occurring after 2020. Continued surveillance, early diagnosis, effective treatment, and public education (and that means talking about it) will be essential to controlling future outbreaks and protecting vulnerable populations.

The information provided in this column is for educational and informational purposes only, and does not constitute medical advice. It is not a substitute for a professional medical consultation, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health provider with any questions you may have regarding a medical condition.

Dr Marcus Stephan