Measuring the impact of skin disease caused by onchocerciasis (river blindness)

River blindness, or Onchocerciasis, is classified as a neglected tropical disease or NTD by the World Health Organization (WHO), meaning that it has been formally acknowledged that steps to control or eliminate the disease should be accelerated. It is caused by a worm parasite, Onchocerca volvulus , and transmitted by bites of blackflies which can be found near fast‐flowing rivers in Latin America and Africa. In humans, the immature worms in the body spread and cause damage to the skin and eyes. Although attention has focused on the devastating effects of blindness caused by this infection, the presence of recognisable skin changes has led to much more information on the widespread distribution of the disease and its impact on humans. For instance, in many countries where the disease occurs, as much as 28% of the population in endemic areas show skin signs of the disease. The presence of skin changes and itching has enabled public health teams with the African Programme for Onchocerciasis Control (APOC) to map the distribution of disease in 20 countries and also to pinpoint communities that require treatment with the oral drug ivermectin. The results of treatment with ivermectin on the skin features of onchocerciasis have been impressive, with major reduction in itching and improvements in skin appearance, as well as social acceptance. Onchocerciasis has been eliminated from some countries such as Ecuador, and rapid progress has been made to reduce the case numbers on the way to elimination in the endemic regions of Africa. In future years this will be combined with control and monitoring of different tropical diseases that are visible and affect the skin, now known as SkinNTDs. Linked Article:   Murdoch M. Br J Dermatol 2021; 184 :199–207.