Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with subcutaneous nodules, pruritus, and/or visual disturbances. History of residence in or travel to endemic regions (sub-Saharan Africa, Latin America, Yemen). Onset of symptoms, duration of skin changes, and presence of ocular symptoms (photophobia, decreased visual acuity) noted.
Clinical Examination Findings
Dermatological exam: Palpable, firm, non-tender subcutaneous nodules (onchocercomata) typically over bony prominences (iliac crest, ribs, trochanters). Skin assessment: Presence of "leopard skin" (depigmentation), lichenification, or "lizard skin" (atrophy). Ocular exam: Slit-lamp evaluation for microfilariae in the anterior chamber or punctate keratitis.
Treatment Protocol
Ivermectin 150 mcg/kg orally, single dose, repeated every 6-12 months to kill microfilariae. Surgical excision of accessible onchocercomata (nodullectomy) may be considered. Monitor for Mazzotti reaction (fever, pruritus, lymphadenopathy) post-treatment.