Immunology of scabies and translational outcomes: identifying the missing links

We propose that a major gap in the control, prevention, diagnosis and treatment of scabies exists because of lack of key translational understandings related to the immunopathology of scabies and the associated severe form of the disease, crusted scabies. Understanding the complex network of innate and adaptive immune responses, including the long lag period from infection to clinical symptoms, is fundamental to developing early interventions and decreasing transmission. Such interventions must be driven by clinical need and include user-friendly translational outcomes for improved control in endemic and resource-poor settings.

In the last few years, we have seen an increase in the molecular characterization of scabies mite proteins. However, owing to limited capacity in scabies immunology-related research, little is still known regarding the immunological effects of the mite or mite products on disease progression or protection.

Detailing the skin immunopathogenesis in relation to scabies, including the role of macrophages, mast cells and eosinophils, as well as the immunomodulatory effects of parasite evasion mechanisms are essential for the rational design of future therapeutic, diagnostic and preventative tools. Resolving this knowledge gap could ultimately lead to significant improvements in clinical and public health interventions. This article proposes a conceptual model for capacity building to inform future research activities in the field.