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Retreatment may be considered at intervals as short as 3 months. Surgical excision of these nodules may be considered to eliminate the adult reproduction of microfilariae. Patients with crusted scabies may require two or more doses of ivermectin spaced at one to two week intervals. Allergic and inflammatory reactions the Mazzotti reaction may occur with ivermectin, probably due to the death of the microfilariae. The treatment of severe Mazzotti reactions has not been subjected to controlled clinical studies. After treatment with microfilaricidal medications, patients with hyperreactive onchodermatitis sowda may be more likely than others to experience severe adverse reactions, especially edema and aggravation of onchodermatitis.
Authored by Dr. Raheel Bengali, MD