Cutaneous Larva Migrans Medication

  • Author: Lydia A Juzych, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 24, 2012
 

Medication Summary

Thiabendazole is currently considered the agent of choice in cutaneous larva migrans (CLM). Topical application is used for early, localized lesions. The oral route is preferred for widespread lesions or unsuccessful topical treatment of cutaneous larva migrans.[13] Other effective alternative treatments include albendazole, mebendazole, and ivermectin.[10] The treatment course of cutaneous larva migrans includes decreased pruritus within 24-48 hours and lesions/tracts resolve in 1 week. Antibiotics are indicated in secondary bacterial superinfections if they occur. As alternative therapy, use liquid nitrogen cryotherapy for progressive end of larval burrow.

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Anthelmintics

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

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Thiabendazole (Mintezol)

 

DOC. Inhibits helminth-specific fumarate reductase, which inhibits microtubule formation, leading to impaired glucose uptake and inhibition of malate dehydrogenase. Third-generation heterocyclic anthelmintic.

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Ivermectin (Stromectol)

 

Semisynthetic macrocyclic lactone antiparasitic agent with broad-spectrum action against nematodes by producing flaccid paralysis through binding of glutamate-gated chloride ion channels. May become DOC because of safety, low toxicity, and single dosing, which enhance patient compliance.

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Albendazole (Albenza)

 

Broad-spectrum benzimidazole carbamate anthelmintic that acts by interfering with glucose uptake and disrupting microtubule aggregation. Use as alternative to thiabendazole.

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Mebendazole (Vermox)

 

Broad-spectrum anthelmintic that inhibits microtubule assembly and irreversibly blocks glucose uptake, thereby depleting the parasites' glycogen stores. Has shown some efficacy in treating CLM.

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Contributor Information and Disclosures
Author

Lydia A Juzych, MD  Senior Staff, Department of Dermatology, Henry Ford Health Sciences Center

Lydia A Juzych, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Medical Student Association/Foundation, American Medical Women's Association, Michigan Dermatological Society, Michigan State Medical Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Margaret C Douglass, MD  Program Director, Department of Dermatology, Henry Ford Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel Mark Siegel, MD, MS  Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

  1. Edelglass JW, Douglass MC, Stiefler R, Tessler M. Cutaneous larva migrans in northern climates. A souvenir of your dream vacation. J Am Acad Dermatol. Sep 1982;7(3):353-8. [Medline].

  2. Herbener D, Borak J. Cutaneous larva migrans in northern climates. Am J Emerg Med. Sep 1988;6(5):462-4. [Medline].

  3. Jones WB 2nd. Cutaneous larva migrans. South Med J. Nov 1993;86(11):1311-3. [Medline].

  4. Patel S, Sethi A. Imported tropical diseases. Dermatol Ther. Nov-Dec 2009;22(6):538-49. [Medline].

  5. Tamminga N, Bierman WF, de Vries PJ. Cutaneous larva migrans acquired in Brittany, France. Emerg Infect Dis. Nov 2009;15(11):1856-8. [Medline].

  6. Archer M. Late presentation of cutaneous larva migrans: a case report. Cases J. Aug 12 2009;2:7553. [Medline].

  7. Bowman DD, Montgomery SP, Zajac AM, Eberhard ML, Kazacos KR. Hookworms of dogs and cats as agents of cutaneous larva migrans. Trends Parasitol. Apr 2010;26(4):162-7. [Medline].

  8. Schuster A, Lesshafft H, Talhari S, Guedes de Oliveira S, Ignatius R, Feldmeier H. Life quality impairment caused by hookworm-related cutaneous larva migrans in resource-poor communities in Manaus, Brazil. PLoS Negl Trop Dis. Nov 2011;5(11):e1355. [Medline]. [Full Text].

  9. Jones CC, Rosen T, Greenberg C. Cutaneous larva migrans due to Pelodera strongyloides. Cutis. Aug 1991;48(2):123-6. [Medline].

  10. Jelinek T, Maiwald H, Nothdurft HD, Löscher T. Cutaneous larva migrans in travelers: synopsis of histories, symptoms, and treatment of 98 patients. Clin Infect Dis. Dec 1994;19(6):1062-6. [Medline].

  11. Rodilla F, Colomina J, Magraner J. Current treatment recommendations for cutaneous larva migrans. Ann Pharmacother. May 1994;28(5):672-3. [Medline].

  12. Van den Enden E, Stevens A, Van Gompel A. Treatment of cutaneous larva migrans. N Engl J Med. Oct 22 1998;339(17):1246-7. [Medline].

  13. Richey TK, Gentry RH, Fitzpatrick JE, Morgan AM. Persistent cutaneous larva migrans due to Ancylostoma species. South Med J. Jun 1996;89(6):609-11. [Medline].

  14. Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology. St. Louis, Mo: Mosby; 2003:1307-09.

  15. Silverberg NB, Jackson RM, Laude TA, Tunnessen WW Jr. Picture of the month. Cutaneous larva migrans (creeping eruption). Arch Pediatr Adolesc Med. Feb 1998;152(2):203-4. [Medline].

 
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