DISCUSSION

DEFINITION
Cutaneous larva migrans is a serpiginous cutaneous
eruption caused by the accidental penetration and
migration of animal hookworm larvae through the
epidermis. The infection has a worldwide distribution and
occurs most frequently in warmer climates. The skin
lesions are usually self-limited

Reference: Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. 2 ed. USA: Elsevier Limited; 2008, page 1406

ETIOLOGY
Cutaneous larva migrans is caused by the larvae of
hookworms that infect domestic dogs and cats
(Ancylostoma caninum, A. braziliense and Uncinaria
stenocephala). The infection is usually acquired by walking
barefoot on groundcontaminated with animal feces, but
other body sites can become infected via contact with
contaminated soil or sand. The larvae enter the skin and
begin a prolonged process of migration within the
epidermis.

Reference: Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. 2 ed. USA: Elsevier Limited; 2008, page 1406

PATHOGENESIS
Humans are aberrant, dead-end hosts who acquire the parasite
from environment contaminated with animal feces.
Larvae remain viable in soil or sand for several weeks.
Larvae penetrate human skin (e.g. walking barefoot), and
migrate within the epidermis up to several centimeters a day.
More commonly, cavities left by the parasite are located within
the stratum corneum and are associated with spongiosis.
Parasite induces localized eosinophilic inflammatory reaction
with edema, spongiosis, and vesicle formation.
Most larvae are unable to develop further or invade deeper
tissues and die after days or months.
Reference: Klaus Wolff MD, Richard Allen, Arturo P., Fitzpatricks Color Atlas and Synopsis Of Clinical Dermatology, 7th ed. USA General Medicine Mc Graw Hill 2013.

CLINICAL MANISFESTATIONS
Patients have intense localized pruritus that begins
shortly after the hookworm penetrates the skin. Several
days later, the pruritus is associated with small vesicles
and/or one or more edematous, serpiginous tracts.
Each larva produces one tract and migrates at a rate of 1
to 2 cm per day. This is commonly the feet, hands and
buttocks.
Due to intense pruritus and scratching, superimposed
bacterial infections may complicate the clinical picture.
Vesicles and bullae may develop in previously sensitized
patients
Reference: Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. 2 ed. USA: Elsevier Limited; 2008, page 1406

Cutaneous larva migrans of the

buttocks.

Cutaneous larva migrans: dorsum of foot: A

serpiginous, linear, raised, tunnel-like
erythematous lesion outlining the path of
migration of the larva.

Reference: Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. 2 ed. USA: Elsevier Limited; 2008, page 1406

LABORATORIUM FINDINGS

Hematology: Peripheral eosinophilia.

Dermatopathology: Part of the parasite can be
seen on biopsy specimens from the advancing
point of the lesion(s).

Reference: Klaus Wolff MD, Richard Allen, Arturo P., Fitzpatricks Color Atlas and Synopsis Of Clinical Dermatology, 7th ed. USA General Medicine Mc Graw Hill 2013.

DIFFERENTIAL DIAGNOSIS
Larva currens caused byStrongyloides stercoralis
Jelly fish sting
Allergic contact dermatitis
Erythema migrans of Lyme borreliosis

Reference: Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. 2 ed. USA: Elsevier Limited; 2008, page 1406

Larva currens caused byStrongyloides

stercoralis. Erythematous, edematous
urticarial lesions in the back and the
abdomen.

Jellyfish sting. Erythematous macules and

papules appear and may develop into
pustules or vesicles. It is quite pruritic.

Reference: Klaus Wolff MD, Richard Allen, Arturo P., Fitzpatricks Color Atlas and Synopsis Of Clinical Dermatology, 7th ed. USA General Medicine Mc Graw Hill 2013.

Allergic contact dermatitis.

Erythema migrans of Lyme

borreliosis

Reference: William D James, Timothy G Berger, Dirk M Elston; Andrews Diseases OF THE Skin Clinical

TREATMENT
Both albendazole (400 mg po daily for 3 days) and
ivermectin (200 g/kg daily for 1 or 2 days) are effective.
Treatment of hookworm folliculitis may require repeated
treatments. Topical therapy with thiabendazole or 10%
albendazole may also be used. Because larvae have
usually migrated beyond the end of the visible skin lesion
and their location cannot be reliably determined, surgical
excision or cryotherapy are not recommended.

Reference: Goldsmith LA, Katz SI, Gilchrest BA. Fitzpatrick's Dermatology in General Medicine. 8 ed. USA: The McGraw-Hill Companies, Inc; 2012, page 2560