Search

PURPOSE: Skin disease is the most common clinically important manifestation of onchocerciasis. Invermectin, a newly available drug, is well tolerated and effective in Onchocerca volvulus infection. However, little information is available regarding its effect on onchocercal skin disease. The purpose of this study was to examine, in patients with well-characterized onchodermatitis, the effect of a single dose of ivermectin. SUBJECTS AND METHODS: Twenty-one persons with severe onchodermatitis were followed over a 6-month period. In order to evaluate the effect of ivermectin on their skin lesions, photographic transparencies were made before treatment and at 3 and 6 months after treatment. These were then evaluated in a blinded fashion. RESULTS: Following a single dose of 150 [mu]g/kg, there was a significant improvement in dermatitis in the first 3 months after treatment. All 14 persons with the worst skin disease showed improvement. The drug had no demonstrable effect on depigmented lesions over the period of observation. Treatment was well tolerated. CONCLUSION: Single-dose ivermectin shows promise as the first acceptable treatment for severe onchocercal dermatitis., Onchocerciasis is a condition resulting from infestation with the worm Onchocerca volvulus, which is characterized by the formation of node-like swellings over the coiled parasites. The disease is prevalent in Africa and Latin America, affecting 17.5 million people. In addition, 85 million people are at risk for developing this infestation. One million people infected with O. volvulus suffer visual complications, and have a greater rate of death than infected persons without visual problems. Onchocerciasis is often complicated by skin disease, which is associated with sleep deprivation due to excessive itchiness; new infection with different organisms; social exclusion; and even suicide. The drug ivermectin was shown to be both safe and effective in decreasing the number of parasites infecting an individual with onchocerciasis. However, the effect of ivermectin on complications of onchocerciasis is not known. Hence, the effect of ivermectin on skin complications associated with onchocerciasis was assessed in 21 infected persons. One dose of 150 micrograms per kilogram of body weight with ivermectin improved skin inflammation (dermatitis) within the first three months of treatment in patients with onchocerciasis. However, the drug had no effect on depigmented lesions, or affected skin areas lacking color. Ivermectin was well tolerated. These findings suggest that ivermectin is beneficial in treating dermatitis associated with onchocerciasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Trachoma, an eye disease caused by repeated infections with Chlamydia trachomatis, is the most prevalent infectious cause of blindness in the world today. Chlamydia eye infection develops as active follicular disease in children, scarring in younger adults, and trichiasis/entropion (the infolding of the margins of the eyelids and associated hairs) in older adults. The latter condition leads to blindness in some individuals. Children of preschool age are the most frequent reservoirs of trachoma. A total of 1,574 children, aged 1 to 9 years old, from 9 villages in Tanzania were included in this epidemiological study. Risk factor assessments were conducted, and demographic data concerning age, sex, personal hygiene and cleanliness of the home, proximity to water, animals present, number of flies around the doorway, type of roof on the house, and religion were collected for each participant. Specimens for cultures of Chlamydia trachomatis and fluorescent antibody studies were obtained from 1,085 of the children; specimens for laboratory testing were not collected from the remaining 31 percent. There was no difference in the proportion of clinical disease in the two groups (cultured and not cultured). The roles of risk factors in the dissemination of trachoma are discussed. Principal risk factors associated with Chlamydia eye infection are: an infected sibling; an excess of flies around the home; cattle herding; a traditional roof on the house; and practicing the local, undefined religion. Younger children and girls were at greater risk of clinical disease, but not of positive laboratory findings. (Consumer Summary produced by Reliance Medical Information, Inc.)

The crystalline lenses of hypercholesterolemic patients were assessed before and after 48 weeks of treatment with lovastatin or placebo to determine the effect of lovastatin on the human lens. Patients were given a biomicroscopic (slit-lamp) examination of the lens, and a previously validated, standardized classification system was used to describe the findings. A total of 8,245 patients were randomly assigned in equal numbers to treatment with placebo or lovastatin 20 or 40 mg once or twice dally in this double-blind, parallel-group study. Statistical analyses of the distribution of cortical, nuclear and subcapsular opacities at 48 weeks, adjusted for age and presence of an opacity at baseline, showed no significant differences (p [less than] 0.01) between the placebo and lovastatin-treated groups. Visual acuity assessments at week 48 were also not found to have significantly different distributions among treatment groups. Moreover, no significant differences were found among the groups in the frequencies of [greater than or equal to] 2-line worsening in visual acuity with concurrent progression in lenticular opacity, cataract extraction, or any spontaneously reported adverse ophthalmologic experience. No evidence was found for an effect of lovastatin on the human lens after 48 weeks of treatment. (Am J Cardiol 1991;67:447-453), Hypercholesterolemia, or an excessively high level of cholesterol in the blood, is recognized to be an important risk factor in the development of cardiovascular disease. In those cases where high blood cholesterol can not be controlled by dietary means (such as a low fat diet), drug therapy must be considered. A new class of cholesterol lowering compounds, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, acts by reversibly inhibiting an early rate-limiting step in the biosynthesis of cholesterol. Lovastatin is the first member of this class that has been marketed, and is currently used in treating primary hypercholesterolemia. At high doses (40 to 60 times the maximum recommended dose), lovastatin has been show to cause opacities in the crystalline lens of the eye in beagle dogs; the mechanism by which this occurred remains unknown. This effect was not seen in early clinical trials, but the lack of a placebo control group and differences in methods used for quantifying lens opacity in those studies prevent strong conclusions from being drawn. As part of a large, ongoing trial to evaluate the safety and efficacy of lovastatin, 8,245 hypercholesterolemic patients were randomly assigned to receive either placebo or 20 or 40 milligrams of lovastatin one or two times daily (four treatment groups and one control group). After 48 weeks of treatment, the crystalline lens was evaluated using a previously validated, standardized classification system, and visual acuity was measured. There were no differences between the control group and any of the treatment groups in either the physical characteristics of the crystalline lens or in visual acuity. When patients were grouped into subsets according to pretreatment visual acuity, the presence of cataracts, or any other ophthalmological criteria, there were still no adverse effects associated with lovastatin for any subgroup of patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Onchocerciasis is a connective tissue disease that can cause blindness. It is caused by a worm known as Onchocerca volvulus (formerly called Filaria volvulus). The disease is common in Latin America and in Africa. It is estimated that 17.5 million people have this disease, 85 million are at high risk for developing the disease, and 1 million people have problems with their vision as a result of the disease. Ivermectin is the drug of choice for treating onchocerciasis. To determine the effectiveness and safety of ivermectin, it was tested in 14,000 people living on a rubber plantation in a tropical rain forest in Liberia. In this population, more than 80 percent of the adults have onchocerciasis. Ivermectin was distributed throughout the community. The treatment program involved taking the drug once a year for three years. The effectiveness of ivermectin was determined by measuring the amount of Onchocerca volvulus present in a small area of skin. After two years of treatment with ivermectin, the amount of Onchocerca in the skin was reduced by 84 percent. Approximately 10 of every 1,000 people experienced an unfavorable reaction to the first treatment of ivermectin, and 4 of every 1,000 people had a bad reaction to the second treatment. Adverse reactions included rash, swelling of the arms and face, body pain and headache. During the third year, 98 percent of the population accepted treatment, indicating that the drug was well received. The results demonstrate that ivermectin is a safe and effective treatment for onchocerciasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Skin cancer is the most common cancer found among the white population of the United States. It is estimated that 500,000 people will develop basal cell carcinoma or squamous cell carcinoma of the skin each year. Actinic keratoses are benign tumors of the skin which are widely regarded as a premalignant condition. It is estimated that 10 to 12 percent of actinic keratoses will develop into squamous cell carcinoma of the skin. To correlate the prevalence of these skin conditions with exposure to the sun, 808 watermen, who commercially gather fish, oysters, and crabs, were interviewed and examined. Twenty-five percent had actinic keratoses. Squamous cell carcinoma was observed in 4.3 percent of the subjects, and basal cell carcinoma was noted in 4.1 percent. Seven men (0.9 percent) had both types of skin cancer. Older age, childhood freckling, and blue eyes correlated with all three types of tumor. Watermen with higher annual ultraviolet B exposure were more likely to have squamous cell carcinoma and actinic keratoses, while watermen who sunburned more readily were more likely to have basal cell carcinoma and actinic keratoses, but not squamous cell carcinoma. The association of squamous cell carcinoma and ultraviolet B exposure was clear, whereas the relationship between ultraviolet light exposure and basal cell carcinoma is uncertain. This suggests that these two types of cancers may have different mechanisms of development. (Consumer Summary produced by Reliance Medical Information, Inc.)

Conjunctivitis is a relatively common eye condition which can cause burning, redness and discharge. The condition is uncomfortable and unattractive and can interfere with the use of contact lenses. Some causes of chronic conjunctivitis include allergic reactions, bacterial and other types of infection, contact lenses, and a variety of other irritants. A group of 58 people were evaluated and treated for chronic conjunctivitis. Diagnosis included obtaining general medical history, history of any eye disorders, and a complete eye examination. Smears for cultures were taken from the conjunctiva, the mucus membrane that lines the eyelids. Gram and Giemsa staining was performed, along with direct immunofluorescent monoclonal antibody staining for Chlamydia trachomatis; herpes simplex virus and chlamydial cultures were also taken. A specific diagnosis was obtained for 69 percent of the patients. The causes included chlamydia in 11 patients; 8 patients had a virus; 6 patients suffered from irritants; a variety of sources were identified for another 15 patients. However, in 18 patients (31 percent) no cause could be isolated. Bacterial cultures helped establish diagnosis in some cases, but was not helpful in detecting the irritants. It is recommended that the initial work up include a complete history of systemic disease, medications used by the patient, and notation of any exposure associated with conjunctivitis. Direct immunofluorescent monoclonal antibody staining was a quick and effective technique for diagnosing chlamydial conjunctivitis. (Consumer Summary produced by Reliance Medical Information, Inc.)