ORIGINAL ARTICLE

Use of Liquid Nitrogen and Albendazole in Successfully

Treating Cutaneous Larva Migrans
Naseema Kapadia1, Tasneem Borhany2 and Maria Farooqui1

ABSTRACT
Objective: To determine the efficacy of combination treatment of Albendazole along with liquid nitrogen in cutaneous larva
migrans.
Study Design: Quasi-experimental study.
Place and Duration of Study: Abbasi Shaheed Hospital and The Aga Khan Hospital, Karachi, from December 2008 to
December 2010.
Methodology: Eighteen cases of cutaneous larva migrans were collected and divided into two groups. Group-A was
administered oral Albendazole 400 mg once per day along with topical steroid and oral cetrizine 10 mg once at night for
7 days. Group-B also received oral Albendazole 400 mg once per day along with cetrizine 10 mg once at night but they
also received single application of liquid nitrogen to freeze the larva.
Results: It was found that in Group-A only 2 out of 9 (22%) showed improvement whereas 78% had to be given liquid
nitrogen cryotherapy 3 7 days after Albendazole to prevent migration of larva. In Group-B, the improvement was 100%
and all 9 patients were successfully treated.
Conclusion: Use of liquid nitrogen along with oral anti-helminths is very effective in treating cutaneous larva migrans than
Albendazole alone.
Key words:

Cutaneous larva migrans.

Albendazole. Liquid nitrogen.

INTRODUCTION
Cutaneous larva migrans (CLM), commonly known as
creeping eruption is caused by the migration of animal
hookworm larvae in the human skin. Common species
causing the condition include Ancylostoma (A.)
braziliense,1 A. caninum, A. ceylanicum, Uncinaria
stenocephala and Bunostomum phlebotomum.2 Patients
present with linear serpiginous track moving forward in
the skin, associated with intense itching and a history of
exposure.3 Bacterial super infection occurs as a result of
scratching. Usually affects people from poor socioeconomic status and can cause considerable morbidity.
Adult hookworm resides in the feline intestine and
secretes the ova in feaces. The ova then hatch into the
larva under hot and humid climate thus infesting soil and
sands on beaches etc. thus affecting humans who come
in contact with the infected soil.4 Lesions commonly
occur on foot, arm and trunk.
The geographical location of Karachi is south of
Pakistan along the coast of Arabian Sea. The hot and
humid climate of the city makes it a perfect spot to
1
2

Department of Dermatology, Abbasi Shaheed Hospital, Karachi.

Department of Community Medicine, Karachi Medical and
Dental College, Karachi.
Correspondence: Dr. Naseema Kapadia, Flat No. 201,
Al-Nafisa Building, Shahra-e-Iraq, Saddar, Karachi.
E-mail: naseemakapadia@yahoo.com
Received July 21, 2012; accepted February 06, 2013.

spread this hookworm infection. Treatment is based on

oral drugs (Albendazole or ivermectin) or the topical
application of Thiabendazole. All of these modalities
have been used with variable results. It is sometimes
necessary to use a combination of both topical and
systemic remedy.
The objective of this study was to determine the efficacy
of combination treatment of Albendazole along with
liquid nitrogen in cutaneous larva migrans.

METHODOLOGY
It was a quasi-experimental study carried out at
Department of Dermatology, Abbasi Shaheed Hospital,
and in the outpatient clinics at the Aga Khan University
Hospital, Karachi during a period of 2 years starting from
December 2008 till December 2010. Patients clinically
diagnosed as suffering from cutaneous larva migrans
were recruited in the study after taking verbal consent
and were explained about the study. All patients with the
disease were included in the study irrespective of age
and sex. Those who received any kind of treatment in
the past or who still had persistent hookworm infection
were excluded from the study. These patients were
divided into two groups comprising of 9 members into
group-A and B respectively. Group-A was given oral
Albendazole 400 mg/day along with topical steroid and
oral Cetrizine whereas group-B was also given
cryotherapy with a freeze time of 30 60 seconds along
with the above mentioned regimen. Clinical response

Journal of the College of Physicians and Surgeons Pakistan 2013, Vol. 23 (5): 319-321

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Naseema Kapadia, Tasneem Borhany and Maria Farooqui

was observed by the same physician during weekly

follow-up of the patients. Efficacy was categorized
according to the time taken for the symptoms and
lesions to settle as under: excellent disappearance of all
baseline signs and symptoms relevant to the lesions;
good (remission but without complete disappearance of
all baseline signs and symptoms relevant to the lesions)
and poor (no remission of baseline signs and symptoms
or recurrence of original lesions despite therapy).
Patients were also inquired about any side effects.
Results were described as mean, range and percentage
values.

RESULTS
Out of 18 patients who participated in the study, 13 were
males and 5 were females. Their ages ranged from 6 to
56 years with mean of and majority were students who
played sports in the evening in gardens and grounds.
Rest were self-employed.
The duration of illness, commonly affected sites and
notable side effects were seen in Table I. Duration of
illness in group-A was 7 10 years whereas it was 6 7
years in group-B. Most commonly affected sites were
limbs and trunks equally observed in both groups.
Commonly noted side effects were blistering (2%) and
transient pigmentation (2%), both in group.
Only 2 out of the 9 patients (22%) were treated with
Albendazole alone whereas 9 out of 9 patients (100%)
were treated successfully with a combination of
Albendazole and cryotherapy.
Table I: Disease duration and side effects in both the groups.
Variables
Duration of illness
Sites affected

Group A

Group B

Albendazole alone

Albendazole + cryotherapy

7 - 10 years

6 - 7 years

Limbs, Trunks

Side effects

Nil

4 (49%)

Blistering

Nil

2 (22%)

Pigmentation

Nil

2 (22%)

Albendazole has been successfully used for the

treatment of cutaneous larva migrans with limited side
effects.8-11 Single dose of 400 mg has been found
effective.12,13 Two recent studies of 1114 and 24 patients
who were treated with Albendazole 400 mg daily for 7
days reported successful cure and no recurrences and
side effects.14,15 The limitations of oral drugs is that they
have been proved teratogenic in pregnancy.16,17 In
another study, oral ivermectin was found to be more
effective than oral Albendazole.18
The study highlighted the importance of combination
therapy in treating cutaneous larva migrans with
promising results. A major limitation of the study was the
small sample size as these were the only encountered
patients during the study period. This combined therapy,
used in this study was not frequently employed in other
studies carried out for the same purpose which adds a
new approach in the local set-up.

CONCLUSION
Combination treatment of oral Albendazole and liquid
nitrogen is efficacious in treating cutaneous larva migrans.

REFERENCES

DISCUSSION
The study unveiled many aspects of the impact of
cutaneous larva migrans on the patients coming to the
outpatient clinics. Although it is a self-limiting disease but
considerable morbidity necessitates treatment.
According to the guidelines published by the Hospital of
Tropical Diseases, three different modalities are initiated
for treatment, first being 10% Thiabendazole cream,
second being oral Albendazole 400 mg/day with or
without cryotherapy and the third being a single dose of
ivermectin.5 Since oral or topical Thiabendazole is not
available in Pakistan, the physicians are left with
choosing between oral Albendazole, cryotherapy and
ivermectin. In the present study, it was found that 2 out
of 9 patients (22%) who were treated with oral
Albendazole alone responded to treatment whereas 7
320

patients (77%) needed cryotherapy as an additional

treatment and were cured after single session of
cryotherapy.6 In group-B all 9 patients (100%) were
cured with the combined therapy suggesting that both
the remedies act synergistically. This was in contrast to
another study which yielded unsuccessful results with
cryotherapy alone, in 6 patients and 2 among them also
reported blisters.7 In another study, 7 patients were
treated with cryotherapy alone and did not report any
cure.6 The reason behind this could be ineffective
technique. The better result in this study may be due to
the use of appropriate long hook with pin point spray of
liquid nitrogen along the whole thread and longer freeze
cycle which minimized the post-inflammatory pigmentation.

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