Ivermectin treatment in severe asymmetric reactive onchodermatitis (sowda) in Sudan

Ivermectin efficacy and post-treatment reactions in asymmetric severe reactive ochodermatitis (sowda) were studied in 8 oatients with sowda svndrome and 6 with mild generalized onchodermatitis in Sudan. Initial skin snips from 12 patients containid microfilariae (l-9 per rng skin). Patients were treated in hospital with a single oral dose of c. 150 μg/kg ivermectin (103-200μg/kg) and monitored for frequency and severity of post-treatment reactions for 4 weeks. Serial samples of heparinized blood were collected over the first 24 h after tieatment for determination of ivermectin pharmacokinetics. Skin snips from all patients on days 3 and 28 revealed no microfilariae. Post-treatment reactions were more common and severe in individuals with sowda; they consisted mainly of musculoskeletal pain, local swellings with pitting oedema, and lymph gland tenderness and enlargement. No relation was established between these reactions, the microfilarial infection intensity, or the plasma pharmacokinetic profiles. A single oral dose of ivermectin cleared the skin of microfilariae and led to improvement of symptoms and dermatological signs of sowda, but resulted in more marked reactions than in cases of generalized onchodermatitis. © 1995 Oxford University Press.