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:
- People who go barefoot at the beaches
- Children playing in sandboxes and crawling on the bare ground
- Carpenters and plumbers working under homes
- 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
- Shortly after entering the skin:
- The larvae elicit intense pruritus
- Tiny papules and even papulovesicles develop
- 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
- Eradicate the larvae
- Eradicate gut Strongyloides
- Treat impetiginization
- Prevent re-infection
Drug treatment
Drugs used are:
- Anthelmintic
- Antihistamine
- 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