Cutaneous larvae migrans

Alternative names
Creeping eruption; Ancylostoma braziliense

Definition
A creeping eruption is a skin rash caused by the migration of dog or cat hookworm larvae beneath the skin.

Causes, incidence, and risk factors

Creeping eruption is more prevalent in countries with warm climates. It affects more children than adults. In the U.S., the Southeastern states have the highest rates of infection. The main risk factor for this disease is contact with damp, sandy soil contaminated with infected cat and dog feces.

The dog and cat hookworm eggs found in the stool of these animals will hatch, and the larvae then infest the soil and vegetation around the droppings. When human skin comes in contact with the infested soil, the larvae burrow into the skin, causing an intense inflammatory response that follows their progress beneath the skin and leads to severe itching. A visible path that marks the migratory trail of the larvae is often seen. The larvae may migrate at rates of a few millimeters to a few centimeters per day.

Symptoms

     
  • Raised, snakelike tracks in the skin that may migrate over time - in severely infested individuals, there may be several tracks noted.  
  • Itching at the site of penetration of the larvae and along the migratory path of the larvae, which may be more severe at night  
  • Occasional blister formation along the migratory path

Signs and tests
This condition is diagnosed based on skin findings noted on physical examination - rarely, a skin biopsy may be done to rule out other conditions.

Treatment
Topical or oral thiabendazole (an anti-parasitic agent) may be used in the treatment of this infection. Other agents such as albendazole and ivermectin are also effective.

Expectations (prognosis)
Creeping eruption is normally a self-limited infection that may clear on its own over a period of weeks to months. Treatment speeds the clearing of this infection and is highly successful.

Complications

     
  • Secondary skin infections caused by scratching  
  • Spread to the lungs or the small intestine (rare)

Calling your health care provider
Make an appointment with your health care provider if you or your child have skin lesions that are snakelike, itchy, and migratory.

Prevention
Public sanitation has decreased the incidence of hookworm infestation in the United States. De-worming of cats and dogs can reduce the incidence among these animals. Wearing shoes in endemic areas (areas where hookworm infections are known to occur frequently) will prevent penetration of the larvae through the feet (a common site).

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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