Version June 2024
| Category of onchocercal skin disease | Main differential diagnosis | Distinguishing features and remarks |
| Acute papular onchodermatitis (APOD) | Miliaria | APOD vesicles are larger and more widely scattered over the trunk, whereas miliaria is usually limited to flexural sites. |
| Bites of Simulium and other insects | These papules are small, closely clustered and many have a tangential punctum. | |
| Chronic papular onchodermatitis (CPOD) | Scabies* | Involvement of extremities and presence of burrows (thin, grayish, reddish, or brownish lines that are 2 to 15 mm long) indicate scabies. Examine other family members. |
| Eczema¶ | Eczema is rarely limited to the buttocks, the commonest site for CPOD. The flat-topped papules of CPOD are characteristic. | |
| Lichenified onchodermatitis (LOD) | Lichenified eczema | Eczema and scabies tend to be symmetric, unlike LOD which may be limited to one limb. |
| Lichenification secondary to chronic scabies | ||
| Atrophy | Senile atrophy | Atrophy associated with old age is usually generalized, whereas onchocercal atrophy may be limited to a particular region (eg, the buttocks). Reserve a clinical diagnosis of onchocercal atrophy to patients <50 years. |
| Depigmentation | Other post inflammatory/post-traumatic hypopigmentation | The shins are common sites for trauma. Onchocercal depigmentation is often quite extensive and bilateral with "spots" of normally pigmented skin centered around hair follicles. |
| Repigmenting vitiligo | Vitiligo typically begins in an acrofacial distribution. Repigmentation of patches of vitiligo may give a "spotty" appearance initially. |
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