Histology: The histopathology is nonspecific unless the actual larva is biopsied. This is highly unlikely, because the larva is typically an estimated 2 to 3 cm ahead of the leading edge of the serpiginous rash, and most biopsies are taken from the serpiginous region. The biopsy specimen shows a lymphocytic dermal infiltrate with eosinophils. Occasionally, a space is seen within the spongiotic epidermis, which indicates the area through which the larva passed.
Treatment: The mainstays of treatment are the anthelmintic agents. Albendazole and ivermectin are the most frequently used medications. Oral ivermectin is well tolerated and works equally as well as the others. Ivermectin binds to glutamate-gated chloride channels in the parasites, allowing free passage of chloride and eventually death of the cell. Thiabendazole and albendazole work by inhibiting microtubule polymerization in the parasite, ultimately leading to its death. Thiabendazole and albendazole can cause severe gastrointestinal side effects, and they are best used topically. A pharmacist can compound these agents into a topical solution to apply to the affected area. Other therapies that have been attempted include cold therapy with topical liquid nitrogen, which is no longer advocated. The larvae have been shown to survive at subfreezing temperatures, and because one cannot predict with high certainty the location of the larva, a large area of skin must be treated with liquid nitrogen for the treatment to be effective.
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