Cutaneous Larva Migrans Medication
- Author: David T Robles, MD, PhD; Chief Editor: William D James, MD more...
Thiabendazole is currently considered the agent of choice in cutaneous larva migrans (CLM) outside the United States. This agent is not available in the United States. Topical application is used for early, localized lesions. The oral route is preferred for widespread lesions or unsuccessful topical treatment of cutaneous larva migrans. Oral thiabendazole may be associated with gastrointestinal complaints, such as nausea or vomiting. Other effective alternative treatments include albendazole, mebendazole, and ivermectin. 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.
For pregnant patients, the treatments listed above are contraindicated. Therefore, symptomatic relief through the use of corticosteroids and antihistamines is first-line therapy.
Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.
Ivermectin is a semisynthetic macrocyclic lactone antiparasitic agent with broad-spectrum action against nematodes by producing flaccid paralysis through binding of the glutamate-gated chloride ion channels. It may become the drug of choice because of safety, low toxicity, and single dosing, which enhance patient compliance.
Albendazole is a broad-spectrum benzimidazole carbamate anthelmintic that acts by interfering with glucose uptake and disrupting microtubule aggregation. Use it as an alternative to thiabendazole.
Mebendazole is a broad-spectrum anthelmintic that inhibits microtubule assembly and irreversibly blocks glucose uptake, thereby depleting the parasites' glycogen stores. It has shown some efficacy in treating cutaneous larva migrans.
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