By Rachel Crumpler
Key Takeaways:
- After dozens of men reported itching and skin bumps, at least two men at Neuse Correctional Institution were diagnosed with scabies in July.
- The response unfolded over weeks, with some men initially receiving diagnoses for other conditions before prison officials provided scabies treatment.
- Controlling the spread of scabies in a prison can be challenging; crowded living conditions can make reinfection difficult to prevent.
For weeks, dozens of men at Neuse Correctional Institution, a medium-custody prison in Goldsboro, have experienced intense itching and pimple-like bumps appearing all over their bodies.
Many of the men believe they have scabies, a skin condition caused by microscopic mites that burrow into the skin and lay eggs.
“You can’t resist scratching at it,” one incarcerated man told NC Health News. “It’s unbelievably uncomfortable.”
“At nighttime, when you lay down to sleep, it feels like things are crawling on you,” another said.
“I’m digging away at a spot on my leg right now,” a third man told NC Health News in July.
The men requested anonymity due to concerns of retaliation from prison staff and officials.
At least two men at the 788-bed prison received diagnoses of scabies in July, according to N.C. Department of Adult Correction communications director Keith Acree. One man was diagnosed at a local hospital, he said.
Scabies outbreaks more commonly occur in crowded or group settings, such as correctional facilities, nursing homes and child care centers, according to the U.S. Centers for Disease Control and Prevention. It spreads through prolonged skin-to-skin contact or by sharing clothing, towels, bedding or furniture used by an infected person. Symptoms can take up to two months to appear after infection, allowing scabies to easily spread undetected.
Acree acknowledged that other men at Neuse Correctional have reported skin symptoms and been screened, but said many did not have exam findings consistent with scabies.
“Dermatologic concerns are one of the most common conditions for which patients seek evaluation, and the same applies to incarcerated individuals, particularly in the summer months,” Acree wrote. “These concerns are naturally heightened when individuals in close proximity such as correctional facilities are diagnosed with conditions such as scabies.”
But four incarcerated men at Neuse separately told NC Health News that they’ve spent many summers in prison without experiencing itching and bumps like this.
One man said weeks of sleepless nights and near-constant itching have taken a toll on his mental health, prompting him to submit a request to see a mental health provider.
“I just think that there’s a culture of nonchalance when it comes to medical treatment for prisoners,” he said. “When you constantly feel like something is crawling on you, that really weighs on your mind, and we’ve been going through this for months.”
The men said they wish their symptoms had been treated more seriously sooner.
“We shouldn’t have to get our families to call Raleigh, to call lawmakers, to call the health department to pressure them,” one said.
Bumps, itching
Four incarcerated men told NC Health News they first noticed bumps on their skin and experienced intense itching in late May. But it wasn’t limited to just them. They said at least two dozen men in their dorm of about 60 men complained of the same symptoms. Soon, they learned of men in another dorm experiencing similar symptoms.
“During the course of the whole month, it was just gradually affecting more people and more people and more people,” one man said.
The itching felt so severe that a handful of men experiencing symptoms filed sick call requests to see a provider in early June. Each sick call came with a $5 medical copay, a cost that deterred some others from putting in a call.
“First, it started off like only between my fingers. The next thing you know, your back. Then your arms, then buttocks area, then my legs to the point I was scratching so bad one day, you would have thought I got into a cat fight,” one incarcerated man said. During a phone call with NC Health News, he said the itching was so intense that he was rubbing his back against a concrete wall as he spoke.
He said he reported itching and bumps over his body and was told it was likely an allergic reaction to a change in laundry detergent. He said he rewashed his clothes, but his symptoms persisted.
Another man said the prison doctor examined his skin and told him he had folliculitis, a common skin condition in which inflamed hair follicles can cause small, pimple-like bumps, and prescribed a steroid cream. He said the cream did not relieve his symptoms.
Other men were told they had heat rash, which Acree said can be a common complaint during the summer months.
One man said his symptoms felt eerily familiar to what he experienced decades earlier while serving in the Marine Corps at Camp Lejeune in Jacksonville.
“I’ve had scabies before,” he said. “I know what scabies are.”
He said he raised his concerns about scabies with prison medical staff in June, but he said treatment for scabies did not come until weeks later.
Scabies identified
After one man was diagnosed with scabies at a local hospital last month, Neuse Correctional began screening and evaluating its population for the condition, Acree said. That process led to a second confirmed case. Acree said other men reported dermatological symptoms that, after examination, were deemed “variably consistent and even inconsistent with the illness.”
Acree said prison officials decided to “preemptively treat all individuals in the dorms where the two cases had arisen” to ensure that potential cases were treated and to reassure the men that their health and safety were being addressed.
According to four incarcerated men, prison medical staff provided scabies treatment to dozens of them on July 9. Staff went through the dorms, collected linens, including bed sheets and clothes, and swapped out mattresses, the men said. The housing area was also sprayed with a disinfectant, they said.
Men were taken to medical and given permethrin cream, a topical cream used to treat scabies by killing mites and their eggs, and instructed to apply it all over their bodies and leave it on overnight.
“They had fresh clothes for us, and we had to rub the cream on,” a man who received the treatment said. “A nurse rubbed it on our back because we couldn’t reach it.”
The same man said he requested oral ivermectin medication at the time, after learning from loved ones that it could be a more effective treatment option, but he said prison medical staff did not offer it.
Federal Bureau of Prisons clinical guidance for scabies recommends oral ivermectin, dosed by weight, as the first-line treatment for scabies due to the risk of treatment failure if permethrin cream is inadequately applied. The topical cream can be difficult to apply everywhere it is needed and have it remain there for the recommended 8 to 14 hours.
When asked if the N.C. Department of Adult Correction has a written protocol on responding to scabies, Acree provided the department’s short two-page nursing protocol for lice and scabies, which does not address specific treatment plans for scabies. The department said it also more broadly follows the CDC’s public health strategies for scabies in institutional settings.
Either treatment method is generally recommended to be repeated about seven days later. However, the four men each said they only received the cream once.
Even if treatment is successful in killing the mites, itching and rash can continue for several weeks as the body’s reaction to the mites resolves and old skin sloughs off.
As symptoms persisted in the weeks after treatment, the men said people in their dorm filed more medical sick calls and grievances over what they viewed as the slow and inadequate response to their medical concerns.
In late July, one man said he was taken to UNC Health Wayne to get medical care for a boil he said had grown to about the size of a golf ball.
“It just oozed all the time and soaked through my clothes,” he said.
While there, he said the doctor prescribed ivermectin tablets to treat his scabies and sectioned him off in the ER with signage and tape.
Another man who said he was among the initial group to notice symptoms in late May told NC Health News that his symptoms persisted for months, reaching a point in which bumps covered as much as 80 percent of his body in August. Meanwhile, he said some people who initially had no symptoms, such as his bunkmate, started to discover bumps.
In early August, Acree said two of the original cases required retreatment and that all individuals housed in the unit were again asked to seek evaluation if they had any dermatologic concerns.
“Through that process, another three individuals, again with subjective concerns (but without physical exam findings consistent with scabies) were also treated,” he wrote, adding that extensive housing and facility mitigation measures were again initiated.
“There have been no further cases or concerns, and our medical staff continues to monitor the situation closely,” Acree wrote on Aug. 10. “Prison staff continue to implement mitigation and preventive measures, including exchanging laundry, bedding and linens, and treating bunks and mattresses as advised by our safety and occupational health team.”
On Aug. 17, prison medical staff offered oral ivermectin tablets, an antiparasitic pill, to anyone in the affected dorms, regardless of symptoms. The living areas were also cleaned again in an effort to stop the spread.
The oral treatment was given in lieu of a second dose of permethrin cream because it is easier to administer to a large number of people, Acree said. A man in the dorm said they were brought down in groups of 10 to receive their medication from the medical provider.
While he said most people in his dorm took the treatment, others who said they didn’t have symptoms declined. Prison medical staff explained to the men that they couldn’t force anyone to take the medication who didn’t want to. That leaves some residing in the dorm concerned about continued spread, they told NC Health News.
Challenges of treatment in prison
Jacob Levitt, a dermatologist at the Metropolitan Hospital Center in New York City, who has treated scabies for more than 20 years, said untreated contacts could contribute to continued spread. Eradicating scabies from a prison requires a coordinated response that treats everyone, not just those who are symptomatic, he said. Failure to do so, particularly in crowded settings, can lead to a cycle of reinfections and more widespread outbreak.
“You need simultaneous broad treatments, especially if it’s in an institutional setting,” he said. “You have to treat the whole hospital floor, all the inmates in a certain place. Because if one person has it and is itchy, the next person won’t necessarily be itchy for six weeks, but then eventually that they will be itchy and then can give it back to the first person who got treated.”
Levitt said scabies is often mistaken for other skin conditions, such as eczema.
“It’s frequently misdiagnosed on both ends of the spectrum, false positives and false negatives, and that’s by educated doctors and dermatologists,” Levitt said.
For doctors who do not specialize in skin conditions, it’s even easier to miss, he said.
Before the cases at Neuse Correctional, Acree said, the N.C. Department of Adult Correction last identified scabies at one of its 55 state prisons more than a year ago.
Once scabies is identified, containing the spread can be especially complicated in prison, where hundreds of people move through shared spaces and have little control over their environment and the treatment decisions of those around them.
“If you have one patient who doesn’t consent to treatment, then he can be a source of continued infection,” Levitt said. “You also have to eliminate [mites] from the environment, which can live for up to two weeks, primarily by laundering clothes and bedding.”
Acree told NC Health News that the Department of Adult Correction’s medical staff “continues to monitor the situation closely.”
“It is common and not at all unexpected that individuals in these circumstances experience anxiety, and even fear,” he wrote. “In addition to education and reassurance, one of the most effective means to calm and reassure these individuals is to widely treat those in proximity to the identified cases.”
Several men who received the ivermectin pills this week said they’ve felt much better since the treatment, though some itching and rash continues.
Acree said a second dose of ivermectin will be provided beginning this weekend and early next week.
“I feel relieved,” one man said. “I really do because you suffer through something that feels like it’s never going to end and now there’s an ending in sight.”
Why scabies can keep people itching
Scabies treatments, such as permethrin cream and ivermectin, kill the parasitic mites under the skin, but itching can persist for weeks even after successful treatment. Santosh Mishra, a neuroscience professor at NC State University studying itch and pain in skin conditions, is examining the molecular basis of scabies itch in an effort to identify how the mites trigger neural pathways that cause the intense itching sensation.
Researchers hope a better understanding of the process could eventually lead to treatments that more quickly relieve itching.
“Knowing the itch mechanism in scabies is very important,” Mishra told NC Health News. “We don’t know much about it, so a lot of the itch problems still persist. We are very excited about this research, and if we identify how the itch is working, that could be translated to treatment improvement.”
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