Updated: 10/30/2016

Cutaneous Larva Migrans

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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

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