Cutaneous Larva Migrans

CUTANEOUS LARVA MIGRANS

Cutaneous larva migrans, or creeping eruption, is an infection of the skin caused by the larvae of a number of animal and human parasites, most commonly the dog and cat hook-worm Ancylostoma braziliense. Eggs discharged in the feces of infected animals and deposited on warm, moist, sandy soil develop filariform larvae capable of penetrating mammalian skin on contact. In the United States, parasite transmission is particularly com-mon in the beach areas of the southern Atlantic and Gulf states.

Although larvae do not develop further within humans, they may migrate within the skin for a period of weeks to months. Clinically, the patient notes a pruritic, raised, red, irregularly linear lesion 10 to 20 cm long. Skin excoriation from scratching enhances the likelihood of secondary bacterial infection. Half of infected patients develop Löffler’s syndrome of transient, migratory pulmonary infiltrations associated with peripheral eosinophilia. The syndrome most probably reflects pulmonary migration of larvae. Larvae are rarely found in either sputum or skin biopsies, and the diagnosis must be established on clinical grounds.

The disease responds well to albendazole, ivermectin, or topical thiabendazole. Anti-histamines and antibiotics may be helpful in controlling pruritus and secondary bacterial infection, respectively.