A histological investigation of skin lesions in onchocerciasis patients from Southern Togo.

Specimens from unselected populations in an area of hyperendemic onchocerciasis were used to describe and quantify histological changes in the upper layers of the dermis and the findings were compared with the macroscopical lesions observed. 553 persons, the inhabitants of two villages in Southern Togo, were examined. 502 biopsies were processed histologically. Onchocerciasis prevalence was over 75% and macroscopical skin lesions were evident in 30--40% of the population examined. Histological changes typical for the infection existed in the dermis in 68.5%. A cellular infiltration was seen in 49%, changes in the elastic or collagenous fibrils in 28.9% of the specimen. The observations are described in detail. Signs of inflammatory as well as primary degenerative changes were seen in biopsies from all age-groups. When microscopic and macroscopic findings are compared, it can be noticed that atrophy may start at an early age without preceeding dermatitis and that inflammatory reactions may occur at all ages. After submersion in saline for 24 hours not all microfilariae had emerged from the skin snips as evidenced by the histological examination. In 12.1% of those that otherwise would have been diagnosed as negative, microfilariae were identified in the sections.