Clinical features:
(1) The patient develops a severe dermatitis with papules and plaques.
(2) The skin may be thickened with scaling, lichenification and deep erosions.
(3) The dermatitis is usually intensely pruritic.
(4) The affected skin is hyperpigmented and darkened with hyperkeratosis and acanthosis.
(5) The dermatitis is often limited to a single extremity, which is usually edematous.
(6) Microfilaria are greatly reduced if a skin biopsy is taken.
(7) The skin lesions and lymphadenopathy will usually revert after treatment with ivermectin or other anti-onchocercal agent.
(8) If untreated it may eventual result in fibrosis and atrophy of the skin ("lizard skin").
Immunologic features:
(1) Regional lymph nodes draining the extremity show reactive follicular hyperplasia.
(2) Serum testing shows high titers of anti-Onchocercal antibodies.
Secondary bacterial infection may develop if the pruritis results in excoriations.
