Cutaneous Larva Migrans

  • Author: David T Robles, MD, PhD; Chief Editor: William D James, MD  more...
 
Updated: May 10, 2016
 

Background

Cutaneous larva migrans (CLM) is the most common tropically acquired dermatosis whose earliest description dates back more than 100 years. Cutaneous larva migrans manifests as an erythematous, serpiginous, pruritic, cutaneous eruption caused by accidental percutaneous penetration and subsequent migration of larvae of various nematode parasites. Cutaneous larva migrans is most commonly found in tropical and subtropical geographic areas and the southwestern United States. It has become an endemic in the Caribbean, Central America, South America, Southeast Asia, and Africa. However, the ease and the increasing incidence of foreign travel by the world's population have no longer confined cutaneous larva migrans to these areas.[1, 2, 3, 4, 5, 6, 7]

Also see the Medscape Reference article Pediatric Cutaneous Larva Migrans.

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Pathophysiology

In cutaneous larva migrans (CLM), the life cycle of the parasites begins when eggs are passed from animal feces into warm, moist, sandy soil, where the larvae hatch. They initially feed on soil bacteria and molt twice before the infective third stage. By using their proteases, larvae penetrate through follicles, fissures, or intact skin of the new host. After penetrating the stratum corneum, the larvae shed their natural cuticle. Usually, they begin migration within a few days.

In their natural animal hosts, the larvae of cutaneous larva migrans are able to penetrate into the dermis and are transported via the lymphatic and venous systems to the lungs. They break through into the alveoli and migrate to the trachea, where they are swallowed. In the intestine they mature sexually, and the cycle begins again as their eggs are excreted.

Humans are accidental hosts, and the larvae lack the collagenase needed to penetrate the basement membrane and invade the dermis. Therefore, cutaneous larva migrans remains limited to the skin when humans are infected.

The pruritic symptoms occur secondary to an immune response to both the larvae and their products.[8]

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Epidemiology

Frequency

Cutaneous larva migrans is rated second to pinworm among helminth infections in developed countries. Prevalence is high in regions of warm climate, where individuals may be more inclined to walk barefoot (eg, beaches, lower socioeconomic communities) and come in contact with animal feces.[9, 10]

Race

No specific racial predilection exists because cutaneous larva migrans depends on exposure.

Sex

Cutaneous larva migrans demonstrates no specific sexual predilection because cutaneous larva migrans depends on exposure.

Age

Cutaneous larva migrans can affect persons of all ages because it depends on exposure, but it tends to be seen in children more commonly than in adults.

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Prognosis

The prognosis for cutaneous larva migrans is excellent. Cutaneous larva migrans is a self-limiting disease. Humans are accidental, dead-end hosts, with the larva dying and the lesions resolving within 4-8 weeks, as long as 1 year in rare cases.

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Patient Education

Persons who travel to tropical regions and pet owners should be aware of this condition. For excellent patient education resources, see eMedicineHealth's patient education article Foreign Travel.

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Contributor Information and Disclosures
Author

David T Robles, MD, PhD Dermatologist, Chaparral Medical Group

David T Robles, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Jacquiline Habashy, MSc Western University of Health Sciences College of Osteopathic Medicine of the Pacific

Jacquiline Habashy, MSc is a member of the following medical societies: American Osteopathic College of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

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

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel Mark Siegel, MD, MS Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Association for Physician Leadership, American Society for Dermatologic Surgery, American Society for MOHS Surgery, International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

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, Michigan State Medical Society, Michigan Dermatological Society, American Medical Association, American Medical Student Association/Foundation, American Medical Womens Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

References
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