Thought to be due to either secondary infection of a scabetic lesion with Staphylococcus aureus or due to an autoantibody response.Results in uncontrolled proliferation of mites (thousands to millions of mites, compared to 10–15 seen in classical scabies).Patients unable to debride mites mechanically e.g., Down syndrome and subungual hyperkeratosis.Reduced peripheral sensation e.g., leprosy.Caused by an altered host immune response.
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