Cutaneous Larva Migrans

Cutaneous Larva Migrans is a localized skin condition manifested by a red, raised, spaghetti string like serpiginous eruption due to migration of the infective larvae of cat and dog hookworms; Ancylostoma braziliense. This condition is also known as ‘creeping eruption’ referring to the moving of the larvae.

The skin changes are an allergic or inflammatory reaction to the larvae and or its products and is the most frequently reported skin condition after overseas travel.

In addition to dog and cat hook worms, others that are implicated include Ancylostoma caninum, Uncinaria stenocephala, and Bunostomum phlebotoman, Gnathostoma, Capillaria and Strongyloides.

Where does it occur?

It occurs worldwide, but the highest prevalence is in tropical countries.

How is it transmitted?

It is transmitted when larvae of dog and cat hookworms penetrate the skin of humans as they walk barefoot on soil or sandy beaches littered with dog or cat feces.

Is it contagious from person to person?

There is no person to person transmission.

What is the risk for travelers?

Risk is moderate to high if walking barefoot on tropical beaches and soil, but also from sunbathing directly on sand without a towel or mat. Hunters and gardeners are also at some risk.

How soon after exposure will one develop symptoms?

Symptoms generally develop within a few hours after exposure.

What are the signs and symptoms?

Initial symptoms may include a stinging or burning sensation as the larvae penetrates the skin and a 2-3 mm red pimple or flat lesion at the site of entry. Subsequently when the larvae migrate one sees the typical spaghetti string like raised, red, 2-4 cm long lesion which can be itchy. The lesion can migrate up to 2 cm a day. Common sites of involvement are the feet, buttocks and abdomen.

Are there any lab tests to diagnose the illness?

No, the diagnosis is made based on physical findings and history of exposure.

Is there any treatment?

Freezing the local skin with ethyl chloride may kill the larvae. Thiabendazole cream is local anti-parasitic agent that may be effective. Oral anti-parasitic agents like Albendazole and Ivermectin are effective.

What preventive measures can be taken?

Avoid walking barefoot in soil or beaches, avoid sunbathing directly on sand, use a towel or sheet as a barrier. Perhaps one should not take dogs and cats to beaches where they inevitably poop! Carting away poop in plastic while helpful does not remove all worms from the sand.

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