Cutaneous Larva Migrans

Aka: Cutaneous Larva Migrans, Creeping Eruption

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II. Epidemiology

  1. Children are most commonly affected
  2. Occurs in Southeast Asia, Central America, South America, Caribbean, Southeastern United States

III. Risk Factors

  1. Utility workers (Plumber's itch)
  2. Beach combers (especially in southeast U.S.)
  3. Post-flood or hurricane

IV. Pathophysiology

  1. Dog and cat Hookworms (related to human Hookworm)
    1. Ancylostoma braziliense
    2. Ancylostoma caninum
  2. Transmission
    1. Feces of dog or cat contaminate moist, warm soil/sand typically in humid environments
    2. Larvae in the soil or sand penetrate skin (esp. when walking barefoot)

V. Symptoms

  1. Serpiginous rash on foot or extremities
  2. Intense Pruritus (especially at night)

VI. Signs

  1. Initial (Larva penetrates skin)
    1. Pruritic erythematous Papule at larval entry site
  2. Subsequent (Larva wanders around in skin)
    1. Serpiginous track advances noticeably each day

VII. Differential Diagnosis

  1. Contact Dermatitis
  2. Strongyloidiasis
    1. Similar rash, but typically associated with gastrointestinal symptoms (esp. Diarrhea)

VIII. 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

IX. 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

X. References

  1. Rabinowitz (2007) Am Fam Physician 76(9):1314-22 [PubMed]
  2. Snellings (2019) Am Fam Physician 100(12): 773-4 [PubMed]

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Related Studies

Ontology: Larva Migrans, Cutaneous (C0546999)

Concepts Disease or Syndrome (T047)
MSH D007815
ICD10 B76.9
SnomedCT 19362000, 187169000, 240853006, 309769003, 240854000, 278041003
English Larva Migrans, Cutaneous, Ancylostoma cutan larva migran, cutaneous larva migrans, cutaneous larva migrans (diagnosis), Uncinarial dermatitis, Cutaneous larva migrans NOS, creeping eruption, ground itch, cutaneous larva migran, sandworm, larva migrans cutaneous, eruption creeping, Hookworm cutaneous vesicle (disorder), Cutaneous larva migrans NOS (disorder), Cutaneous larval migrans, Ground itch, Creeping eruption, Cutaneous larva migrans, Ancylostomal cutaneous larva migrans, Duckhunter's itch, Hookworm cutaneous vesicle, Larva migrans of skin, Plumber's itch, Sandworm, CLM - Cutaneous larva migrans, Cutaneous larva migrans (disorder), Larva migrans of skin (disorder), Ancylostomal cutaneous larva migrans (disorder), coolie; itch, creeping eruption; eruption, cutaneous; larva migrans, eruption; creeping eruption, eruption; skin, creeping eruption (meaning hookworm), ground; itch, itch; coolie, itch; ground, larva migrans; cutaneous, skin; eruption, creeping eruption (meaning hookworm), Cutaneous Larva Migrans
Italian Anchilostoma cutaneo, Larva migrans cutanea
Japanese 皮膚幼虫移行症, ﾋﾌﾖｳﾁｭｳｲｺｳｼｮｳ
Portuguese Larva Migrans Cutânea, Larva cutânea migrante
Spanish Larva Migrans Cutánea, dermatitis uncinarial, anquilostomiasis cutánea, SAI, anquilostomiasis cutánea, SAI (trastorno), larva migrans cutánea, SAI, Cutaneous larva migrans NOS, larva migrans cutánea, SAI (trastorno), anquilostomiasis cutánea, erupción reptante, larva migrans cutánea, larva migrans de piel (trastorno), larva migrans de piel, larva migrante cutánea anquilostómica (trastorno), larva migrante cutánea anquilostómica, larva migratoria cutánea (trastorno), larva migratoria cutánea, larva migratoria de piel, prurito del suelo, Larva cutánea migrans
French Larva migrans cutanée
German Kutane Larva migrans, Larva migrans cutanea, Larva migrans, kutane
Czech Kožní larva migrans, larvy migrující v podkoží, larva migrans cutanea, kožní larva migrans
Hungarian cutan larva migrans
Dutch coolie; itch, creeping eruption; eruptie, cutaneus; larva migrans, eruptie; creeping eruption, eruptie; huid, creeping eruption (haakwormziekte), ground; itch, huid; eruptie, creeping eruption (haakwormziekte), itch; coolie, itch; ground, larva migrans; cutaneus, cutaneuze larva migrans, Cutane larva migrans, Larva migrans cutaneus
Derived from the NIH UMLS (Unified Medical Language System)

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