Snapshot A 3-year-old girl complains of itchy feet for the past few days. There is a stringy lesion that travels a little every day. Her favorite thing to do is play in the local playground with her friends in the sandbox. Introduction Cutaneous migratory infection caused by hookworm larvae most commonly Ancylostoma braziliense (hookworm of dogs and cats) Larvae must penetrate skin can migrate under skin “creeping eruption” transmitted via animal feces History is important here in tropical or subtropical regions recent beach vacation sandboxes Presentation Symptoms itchy migrates 2 cm daily Physical exam erythematous, elevated, serpiginous red-to-purple lesions commonly on feet and ankles Evaluation Diagnosis by clinical history and exam skin biopsy typically not needed Laboratory values eosinophilia Differential Diagnosis Allergic contact dermatitis Atopic dermatitis Scabies Treatment Medical treatment thiabendazole – first-line treatment albendazole ivermectin Prognosis, Prevention, 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