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Updated: Oct 30 2016

Cutaneous Larva Migrans

  • 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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