The immunology of scabies

Individuals with scabies react to bites by generating a cell-mediated immune response at the bite site. This elicits a very itchy papule that is often excoriated. Sometimes ulcerated papules, vasculitis, and nodules develop as a result of other immunologic reactions in skin. Immunologic reactions mediated by antibodies of the immunoglobulin G (IgG), IgM, and especially, IgE classes may also be involved. None of these reactions have been shown to eliminate all mites from the skin surface, but locally these reactions may prevent the epidemic multiplication of scabies' organisms on the skin surface, as observed in some patients with crusted scabies.