Updated: 12/16/2021

Cutaneous Larva Migrans

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  • Snapshot
    • A 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)
  • Prevention, and Complications
    • Prevention
      • avoid direct skin contact with fecally contaminated soil or sand
    • Complications
      • secondary infection causing cellulitis
      • eczematous inflammation
      • allergic reaction
      • Loeffler syndrome (rare)
  • Prognosis
    • If untreated, larvae die on own in 2 - 8 weeks
    • If treated, resolution occurs 2 - 3 days after therapy begins
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