CUTANEOUS LARVA

MIGRANS
KELOMPOK 6
 Definition

Cutaneous larva migrans or creeping

eruption has been known since 1874 and
later in 1929 it is known that the disease is
associated with subcutaneous migration of
Ancylostoma larvae.
 Cutaneous larva migrans (CLM) is a skin
eruption in the form of serpiginous
propagation, as a skin hypersensitivity
reaction to invasion of hookworm larvae or
nematodes or the products.
 Epidemiology

found in tropical or subtropical regions

on tourists (travellers) who return from
tropical countries
children who often walk barefoot or often
relate to the soil or sand that affects the
larvae
USA : 6.7% of 13,300 tourists
overall prevalence 8.2%
 Etiology

Ancylostoma braziliense and Ancylostoma

caninum
Uncinaria stenocephala and Bunostomum
phlebotomum
Echinococcus, Strongyloides sterconalis,
Dermatobia maxiales, and Lucilia Caesar
Some types of flies, such as Castriphilus
Pathophisiology
 Clinical features

Itching and hot sensation around the lesion

Papules - linear or twisty lesions, polycyclic,
serpiginous, and forming a tunnel, reaching
several centimeters
Erythematous
Pruritic especially at night and pain
Predilection : feet, palm, hand, anus,
buttocks, and thigh
 Diagnose

Anamnesis
Patients who live or have traveled to
warm and moist tropical or subtropical
regions
 Physical examination

Visible lesions such

as straight or twisted
yarn, and there are
papules and vesicles on it

Pict 1. Serpiginous, erithematous,

visible lesion on arm flexor aspect
(SardesaiVR.,Agarwal TD., Dahiya RPS.
Cutaneus Larva Migrans. Journal of
Pediatric 2014. )
 Another examination
Lab : Increased IgE, peripheral eosinophilia
Skin biopsy : it appears that the nematode
larvae are trapped between the follicle
channels
 Treatment

Before 1960, treatment of CLM are etyl chloride

spray (spray along the lesion) but this
treatment isnt often success because the
location of the larvae cant identified
specifically and can damage other tissue
around the lession.
After that there are many other treatment with
minimal side effect and more advantages such
as tiabendazole, albendazole, ivermectin
Treatment
No Type of drugs Advantage disadvantage
1. Spray categories fast and easy to find larvae cant
(45 second until 1 minutes Easy to use identified
given) specifically
can damage
other tissue
around the
lession

2. Tiabendazole more effective than nausea and

(25-50 mg/kgbw/day) spray vomitting
2-5 days
3. Albendazole effective in three not effective
(400-800 mg/day) days given continously with single dose
3 days (92-100%)
4 Ivermectin more effective to difficult to find
(200 g/kgbw) reduce itchy/pruritic contraindication
Single dose (77-100%) in child < 5 y.o
and pregnant
woman
 Preventive method

Avoid direct contact with contamination

objects
Good vaccination for pets
Good hygiene in playground or
environment