Cutaneous Larva Migrans 

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

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; 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]

Also see the eMedicine Pediatrics articles Ancylostoma Infection and 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 are believed to lack the collagenase enzymes required to penetrate the basement membrane to invade the dermis. Therefore, cutaneous larva migrans remains limited to the skin when humans are infected.

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Epidemiology

Frequency

United States

Cutaneous larva migrans is rated second to pinworm among helminth infections in developed countries.

Mortality/Morbidity

Cutaneous larva migrans is benign and self-limited but can cause a disturbing pruritus.

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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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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