Onchocerciasis is a common, chronic multisystem disease with dermatologic, ocular, and systemic manifestations. Although the disease is endemic in Africa, Latin America, and Yemen, imported cases have been described in the United States. The causative organism, Onchocerca volvulus, is transmitted by the bite of a black fly of the genus Simulium. There are a number of cutaneous manifestations of the disease, including onchocercomas, which are subcutaneous bundles of worms. The antiparasitic agent ivermectin is the drug of choice for both prophylaxis and treatment of active disease.

Contact with insects may induce cutaneous or systemic reactions, ranging from little more than annoying to life threatening. The diagnosis depends on maintaining a high index of suspicion and being familiar with the insect fauna of the patient’s environment and area of travel.

Our study showed 70%, 61.8%, and 56. 4% protection with Tecnu, Goop, and Dial, respectively, when compared to the positive control, or to the possible maximum response, with a cost per ounce (in a local drug and automotive store) of $1.25, $0.07, and $0.07, respectively, for a decrease in protection that is nonsignificant.