Updated: 10/30/2016

Cutaneous Larva Migrans

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  • Cutaneous Larva MigricansA 40-year-old man is alarmed by a snake-shaped lesion on his feet. The lesion migrates around 2 cm every day and his feet are extremely itchy. Three weeks ago, he returned from a beach vacation in the Caribbean, where he walked around barefoot in the sand.
Introduction
  • Cutaneous migratory infection caused by hookworm larvae
    • most commonly Ancylostoma braziliense (hookworm of dogs and cats)
    • others: Necator, Strongyloides
  • Larvae must penetrate skin
    • can migrate under skin
    • creeping eruption
    • transmitted via animal feces
  • History is important here
    • in tropical or subtropical regions
    • typically 3 weeks after beach vacation involving sand
    • children who play in sandboxes can be affected
    • carpenters and plumbers who work under houses can be affected
Presentation
  • Symptoms
    • very itchy
    • migrates 2 cm daily
  • Skin exam
    • erythematous, elevated, serpiginous red-to-purple lesions
    • commonly on feet and ankles
    • can also affect buttocks, genitals, hands
  • Non-skin findings
    • Loeffler syndrome
      • eosinophils accumulate in lungs in response to parasitic infection
Evaluation
  • Diagnosis by clinical history and exam
    • skin biopsy typically not needed
  • Laboratory values
    • eosinophilia
    • increased IgE levels
  • Radiograph of chest if Loeffler syndrome is suspected
    • patchy infiltrates
Differential Diagnosis
  • Allergic contact dermatitis
  • Atopic dermatitis
  • Scabies
Treatment
  • Medical treatment
    • thiabendazole (topical) – first-line treatment
    • albendazole (oral)
    • ivermectin (oral)
Prognosis, Prevention, and Complications
  • Prognosis
    • if untreated, larvae die on own in 2 - 8 weeks
    • if treated, resolution occurs 2 - 3 days after therapy begins
  • Prevention
    • avoid direct skin contact with fecally contaminated soil or sand
  • Complications
    • secondary infection causing cellulitis
    • eczematous inflammation
    • allergic reaction
    • Loeffler syndrome (rare)

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