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Dermatologic Manifestations of Onchocerciasis (River Blindness) Medication

  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: William D James, MD  more...
 
Updated: Oct 06, 2015
 

Medication Summary

Ivermectin is the drug of choice in the treatment of onchocerciasis. The addition of 6 weeks of doxycycline to ivermectin has been shown to be effective in reducing the microfilarial load, which may affect transmission and may prevent or reduce onchocerciasis-related blindness. Suramin may be indicated for use only if ivermectin cannot adequately control the disease. Amocarzine has not been shown to be effective in treating onchocerciasis.[21] Both suramin and amocarzine are capable of destroying adult worms. DEC therapy is no longer recommended.

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Anthelmintics

Class Summary

Biochemical pathways in parasites are sufficiently different from those in the human host to allow selective interference by using chemotherapeutic agents in relatively small doses.

Ivermectin (Mectizan, Stromectol)

 

Ivermectin is an oral, semisynthetic, broad-spectrum anthelmintic agent isolated from S avermitilis. It binds selectively with glutamate-gated chloride-ion channels in invertebrate nerve and muscle cells, causing cell death. Its half-life is 16 hours, and it is metabolized in the liver. The usual frequency is every 12 months for mass treatment programs, but individual therapy may be given in intervals as short as 3 months.

Suramin (Metaret)

 

Suramin is a polyanionic compound developed as an antiparasitic drug for the treatment of CNS trypanosomiasis. It is an intravenous antiparasitic agent effective against African trypanosomiasis and onchocerciasis. Most often, a 10% solution is used. Administration of a test dose of 100-200 mg is advised before initiating treatment.

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Antibiotics

Class Summary

When used concurrently with ivermectin therapy, tetracycline antibiotic therapy (eg, with doxycycline) depletes Wolbachia endosymbionts and may decrease transmission and reduce or prevent onchocerciasis-related blindness secondary to disruption of female nematode embryogenesis.[22]

Doxycycline (Doryx, Vibramycin)

 

Doxycycline is a broad-spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. It is almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.

Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

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Contributor Information and Disclosures
Author

Jason F Okulicz, MD, FACP, FIDSA Director, HIV Medical Evaluation Unit, Infectious Disease Service, San Antonio Military Medical Center; Associate Professor of Medicine, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences; Clinical Associate Professor of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Clinical Instructor, Feik School of Pharmacy, University of the Incarnate Word

Jason F Okulicz, MD, FACP, FIDSA is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Donald Belsito, MD Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: New York County Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, American Contact Dermatitis Society, Dermatology Foundation, Dermatologic Society of Greater New York, Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

References
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Leopard-spot pattern of depigmentation on the shins. Courtesy of Brooke Army Medical Center teaching file. All images are in the public domain.
Dermatitis associated with microfilaria. Courtesy of Brooke Army Medical Center teaching file. All images are in the public domain.
Hanging groin sign. Courtesy of Brooke Army Medical Center teaching file. All images are in the public domain.
Hanging groin sign. Courtesy of Brooke Army Medical Center teaching file. All images are in the public domain.
Onchocercoma. Courtesy of Brooke Army Medical Center teaching file. All images are in the public domain.
Onchocercoma. Courtesy of Brooke Army Medical Center teaching file. All images are in the public domain.
Photomicrograph of a skin biopsy specimen from a patient with onchocerciasis. A worm is shown in cross-section. Courtesy of Brooke Army Medical Center teaching file. All images are in the public domain.
Photomicrograph from a gravid female worm (hematoxylin and eosin]). Courtesy of Brooke Army Medical Center. All images are in the public domain.
 
 
 
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