Late-onset onchocercal skin disease among Ethiopian immigrants

Summary Background Onchocerciasis is an infectious disease caused by the filaria Onchocerca volvulus. Very little is known regarding onchocerciasis imported from endemic to nonendemic areas.

Objectives To evaluate pruritic dermatitis simulating atopic dermatitis in Ethiopian immigrants in Israel. Patients and methods A retrospective study of 27 Ethiopian immigrants to Israel was conducted. Demographics and clinical and laboratory data were collected.

Results Of the group of 27 patients, 10 (37%) were men and 17 (63%) were women. The average age at referral was 29 years. All of the patients emigrated from Kuwara, Ethiopia. Diagnosis was done by either positive skin snip test or immunoglobulin (Ig) G4 serology of onchocerciasis in 14 patients. The most common presentation was a combination of lichenified onchodermatitis with atrophy and depigmentation (36%). Eosinophilia and elevated IgE levels were common. Seventeen patients were treated with a single administration of oral ivermectin 200 μg mg^-1. Thirteen patients responded to the treatment.

Conclusions Immigrants from endemic regions to developed countries presenting with pruritic diseases, especially those with a clinical picture suggestive of atopic dermatitis, should be evaluated for possible onchocerciasis infection. Ivermectin, a relatively safe and low-cost treatment, should be considered even in the absence of a proven disease. Physicians should have a high index of suspicion in patients with the corresponding residential history. What's already known about this topic? Onchodermatitis is a common manifestation of the infection caused by the filaria Onchocerca volvulus. What does this study add? We summarized our experience with 27 immigrants from a country endemic for onchocerciasis, who presented with pruritic eruption suggestive of atopic dermatitis. Clinicians must be aware of this entity and these patients should be evaluated and treated appropriately. It also may be of value to initiate a relatively safe and low-cost treatment with ivermectin, even in the absence of a proven disease.