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Cutaneous larva migrans
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Hookworm-related cutaneous larva migrans (Hr-CLM) is a disease caused by percutaneous penetration and migration of animal hookworm larvae in the human skin, most commonly Ancylostoma braziliense, Ancylostoma caninum, Uncinaria stenocephala, and Bunostomum phlebotomum. People at risk are the inhabitants and returning travelers from tropical/subtropical countries and children playing in sandpits. The incubation period can vary between a few days and 7 months after exposure to contaminated soil or sand. The clinical picture is that of a characteristic ‘creeping eruption’ with serpiginous, papular, vesiculobullous, and erythematous lesions due to the presence of moving parasites. The common sites involved are the feet, buttocks, and thighs. Rare complications include pulmonary eosinophilic infiltrates, hookworm folliculitis, and oral mucosal lesions.
Management Strategy
Hr-CLM is self-limiting: most lesions resolve within 2–8 weeks because the human is a ‘dead-end host.’ However, the lesions can be extremely pruritic and extensive, significantly reducing quality of life, thus necessitating treatment.
The systemic treatment normally used by the authors for patients over the age of 2 years is oral albendazole 400 mg daily for 3 days. An alternative is ivermectin given as a single dose of 12 mg orally (or 200 mcg/kg) for adults and children older than 5 years or more than 15 kg in weight. Topical treatment usually takes the form of thiabendazole in a suitable lipophilic vehicle.
Specific Investigations
Clinical appearance is characteristic. Peripheral eosinophilia and raised serum IgE may be seen.
One-week therapy with oral albendazole in hookworm-related cutaneous larva migrans: a retrospective study on 78 patients
Veraldi S, Bottini S, Rizzitelli G, et al. J Dermatolog Treat 2012; 23: 189–91.
Seventy-eight patients with multiple and/or extensive lesions of Hr-CLM were treated with albendazole 400 mg/day for 1 week. Cure rate was 100% at 3-months’ follow-up. The disappearance of pruritus was reported after 2–3 days and skin lesions after 5–7 days of therapy. The authors concluded the regime was very effective with no severe side effects reported.
Management of imported cutaneous larva migrans: a case series and mini review
Kincaid L, Klowak M, Klowak S, et al. Travel Med Infect Dis 2015; 13(5): 382–7.
Twenty-five patients were identified, 16 of whom had localized lesions to the feet. Twenty-three responded appropriately to a 3-day course of 400 mg albendazole. Two patients required a repeat course of treatment.
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