Cutaneous larva migrans, creeping eruption, sand worm
- Correspondence to:
Dr R M Shinkar
Department of Paediatrics, James Paget Hospital, Lowestoft Road, Gorleston, Great Yarmouth NR31 6LA, UK;
Cutaneous larva migrans is the most common tropically acquired dermatosis. It is characterised by erythematous, serpiginous, pruritic, cutaneous eruption caused by percutaneous penetration and subsequent migration of larvae of various nematode parasites.1 It is most commonly found in tropical and subtropical geographic areas; however, because of the ease and the increasing incidence of foreign travel by the world’s population, cutaneous larva migrans is no longer confined to these areas.
We report a 2 year old girl who presented with a four month history of itchy rash on her thigh. There was a history of travel to Jamaica before the onset of the rash. She had a serpigenous, erythematous, itchy rash on the back of her right thigh. She was successfully treated with thiabendazole.
The larvae of the dog hookworms A braziliense, A caninum, and U stenocephala, together with certain other parasites, produce in humans a skin eruption which differs from that caused by “human” hookworms. Most infections are due to A braziliense. Infections occur on sandy bathing beaches, in children’s play areas, and by contact with pet sandboxes. Lesions are most common on the lower legs and buttocks, but also occur on the arms, hands, and face.2
The larva, after penetrating the epidermis, is unable to enter the blood or lymph streams and instead burrows just below the corium, travelling up to an inch a day. Papules mark the site of entry and advancing end of the larva, and the tunnelling causes linear, slightly elevated erythematous and serpigenous areas which itch intensely. Vesicles may form along the course of the tunnels and scaling develops as the lesions age. They may develop secondary bacterial infection. The most common sites in children are the buttocks and the dorsa of the feet, but any area can be affected. The eruption generally disappears after 1–2 months, but may present for 6 months or longer.
The time honoured treatment for cutaneous larva migrans is by freezing of the area with ethyl chloride or similar refrigerant sprays. Diethylcarbamazine or thiabendazole can be used. Thiabendazole can also be used topically.3
Competing interests: none declared
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