Cutaneous larva migrans (Creeping eruption)

Introduction

Cutaneous larva migrans is an infection of the skin by various nematode larvae which migrate, but never reach internal organs or complete their life cycles.
Migration leads to twisting, winding linear skin lesions produced by the burrowing of larvae.
Victims of cutaneous larva migrans are usually:

  1. People who go barefoot at the beaches
  2. Children playing in sandboxes and crawling on the bare ground
  3. Carpenters and plumbers working under homes
  4. Gardeners

The most common causes are cat and dog hookworm

  • Ancylostoma braziliense
  • Ancylostoma caninum
  • Necator americanus
  • Gnathostoma spinigerum
  • Strongyloides stercoralis.

Symptoms and Clinical features of cutaneous larva migrans

  1. Shortly after entering the skin:
  • The larvae elicit intense pruritus
  • Tiny papules and even papulovesicles develop
  1. As the larvae begin to migrate:
  • Intermittent stinging pain occurs
  • Thin red, tortuous and minimally elevated lines are formed in the skin
    • Rate of migration varies with the species
    • Pruritus and excoriation promote secondary bacterial infections
  • Intestinal infections with Strongyloides stercoralis may be associated with perianal larva migrans syndrome called ‘larva currens’ because of the rapidity of larval migration (up to 10 cm/hr)
  • Larva currens is an autoinfection caused by penetration of the perianal skin by Strongyloides stercoralis

Differential diagnosis

  • Ring worm

Complications of cutaneous larva migrans

  • Secondary bacterial infection
  • Fatal Strongyloides stercoralis hyperinfection in immunocompromised patients

Investigation

  • None useful to management

Treatment for cutaneous larva migrans

Treatment objectives

  1. Eradicate the larvae
  2. Eradicate gut Strongyloides
  3. Treat impetiginization
  4. Prevent re-infection

Drug treatment

Drugs used are:

  1. Anthelmintic
  2. Antihistamine
  3. Antibiotics

Ivermectin

  • Adult: 150 microgram/kg orally as a single dose
  • Child over 5 years old: 200 micrograms/kg orally daily for 2 days

Or:

Albendazole

  • Adult: 400 mg orally twice daily for 2 days, repeated after 3 weeks if necessary
  • Child over 2 years: 400 mg once or twice daily for 3 days, repeated after 3 weeks if necessary

Antihistamines are used for pruritus while antibiotics are used for secondary bacterial infections.

Prevention of cutaneous larva migrans

  • Avoid direct contact of skin with sand