Diagnosis: Cutaneous Larva Migrans (creeping eruption)
The patients eruption cleared rapidly after receiving oral Thiabaendazole three 500 mg tabs bid for 2 successive days.
Discussion:
Cutaneous larva migrans is caused by infestation of the skin with nematode larvae. The most common nematode is the dog hookworm, Ancylostoma braziliensis, A. canum, or Uncinaria stenocephala (1). Similar eruptions can also be caused by the human hookworms A. duodenale or Necator americanus. Ova in fecally contaminated soil hatch into larvae that penetrate skin coming in contact with the soil. As the larvae tunnel through the skin, the overlying erythematous eruption migrates. Walking bare-foot, particularly along beaches, is a common history in individuals afflicted with this disorder. The infestation is usually self-limited , clearing in 2 to 8 weeks. In one case, however, the disease persisted for 22 months, failing one course of topical thiabendazole before responding to oral thiabendazole (2). Treatment options include either oral Thiabendazole, topical Thiabendazole, reported to be effective in 98% of cases (3), Albendazole and Ivermectin (4) shown to be effective in a single oral dose of 200 mg. Cryotherapy of the advancing edge of the larva can also be effective.
REFERENCES:
1. Jelinek T, Maiwald H, Northdurft, HD, Loscher T: Clinical Infectious Diseases, 19 (6), 1062-1066, 1994.
2. Richey TK, Gentry RH, Fitzpatrick JE, Morgan, AM: Southern Med J, 89,609-611,1996.
3. Davies HD, Sakuls P, Keystone JS: Arch Derm, 129,588-591, 1993.
4. Caumes E, Carriere J, Datry A, Gaxotte P, Danis M, Gentilini M: Amer J Trop Med & Hygiene, 49,641-644, 1993.
My thanks to Dr. Michael Turner for his assistance in preparing this
case.