Cutaneous Larva Migrans

1. Epidemiology
   1. Children (most commonly affected)
   2. Utility workers (Plumber's itch)
   3. Beach combers (especially in southeast U.S.)
2. Cause
   1. Dog and cat Hookworms (related to human Hookworm)
      1. Ancylostoma braziliense
      2. Ancylostoma caninum
3. Transmission
   1. Feces of dog or cat contaminate moist, warm soil/sand
   2. Larvae in the ground penetrate skin
4. Symptoms
   1. Serpiginous rash on foot or extremities
   2. Intense Pruritus (especially at night)
5. Signs
   1. Initial (Larva penetrates skin)
      1. Pruritic Papule at larval entry site
   2. Subsequent (Larva wanders around in skin)
      1. Serpiginous track advances noticeably each day
6. Differential Diagnosis
   1. May be confused with Contact Dermatitis
7. Management
   1. Cryotherapy
      1. Ethyl chloride sprayed at advancing track edge
   2. Topicals
      1. Thiabendazole cream
   3. Systemic
      1. Ivermectin (Stromectol) 150-200 ug/kg for 1 dose
   4. Eosinophilic enteritis Syndrome (rare complication)
      1. Mebendazole 100 mg bid for 3 days
         1. Mebendazole no longer available as of 2012
         2. Use Albendazole instead
8. Prevention
   1. Avoid skin contact with infected ground
      1. Prohibit dog walking on beach
      2. Avoid allowing pets in sand box
   2. Pet care
      1. De-worm household pets
      2. Clean up pet droppings