Cutaneous larva migrans

Cutaneous larva migrans

Weronika Szczecinska and Anthony Abdullah

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 Bunostonum phlebotomum. People at risk are the inhabitants and returning travellers from tropical and subtropical countries, and children playing in sandpits. Incubation period can vary between a few days to 7 months after exposure to contaminated soil or sand. The clinical picture is that of 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

Hookworm-related cutaneous larva migrans is self-limiting: most lesions resolve within 2 to 8 weeks because the human is a ‘dead-end host’. However, the lesions are extremely pruritic, can be extensive and can significantly reduce the quality of life, so treatment is often required.

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 µg/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.

First-line therapies

Systemic albendazole	B
Systemic ivermectin	B

One-week therapy with oral albendazole in hookworm-related cutaneous larva migrans: a retrospective study on 78 patients.

Veraldi S, Bottini S, Rizzitelli G, Persico MC. 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 to 3 days and skin lesions after 5 to 7 days of therapy. The authors concluded that this regimen was very effective and had no severe side effects.

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Tags: Treatment of Skin Disease Comprehensive Therapeutic Strategies

Aug 7, 2016 | Posted by admin in Dermatology | Comments Off

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