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 patients with sowda syndrome and 6 with mild generalized onchodermatitis in Sudan. Initial skin snips from 12 patients contained microfilariae (1-9 per mg skin) . Patients were treated in hospital with a single oral dose of c. 150 mu g/kg ivermectin (103-200 mu g/kg) and monitored for frequency and s everity of post-treatment reactions for 4 weeks. Serial samples of hep arinized blood were collected over the first 24 h after treatment for determination of ivermectin pharmacokinetics. Skin snips from all pati ents on days 3 and 28 revealed no microfilariae. Post-treatment reacti ons were more common and severe in individuals with sowda; they consis ted mainly of musculoskeletal pain, local swellings with pitting oedem a, and lymph gland tenderness and enlargement. No relation was establi shed between these reactions, the microfilarial infection intensity, o r the plasma pharmacokinetic profiles. A single oral dose of ivermecti n cleared the skin of microfilariae and led to improvement of symptoms and dermatological signs of sowda, but resulted in more marked reacti ons than in cases of generalized onchodermatitis.