Pediatric Cutaneous Larva Migrans Medication

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 10, 2012
 

Anthelmintics

Class Summary

Anthelmintics are the drug of choice for cutaneous larva migrans (CLM). Parasite biochemical pathways are different from the human host; thus, toxicity is directed to the parasite, egg, or larvae. Mechanism of action varies within the drug class. Antiparasitic actions may include the following:

  • Inhibition of microtubules causes irreversible block of glucose uptake
  • Tubulin polymerization inhibition
  • Depolarizing neuromuscular blockade
  • Cholinesterase inhibition
  • Increased cell membrane permeability, resulting in intracellular calcium loss
  • Vacuolization of the schistosome tegument
  • Increased cell membrane permeability to chloride ions via chloride channels alteration
View full drug information

Ivermectin (Stromectol)

 

Broad-spectrum anthelmintic that is not FDA approved for the treatment of CLM but is suggested as DOC by many studies. Single-dose therapy makes this drug convenient. Available in the United States because of FDA approval for treatment of onchocerciasis and strongyloidiasis. Selectively binds with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death. Half-life is 16 h; metabolized in liver. Available in 3 mg tabs.

View full drug information

Albendazole (Albenza)

 

Broad-spectrum antihelminthic drug used in nematode and cestode infestations; not FDA approved for treatment of CLM but has been shown by many studies to be highly effective with no or minimal adverse effects. Available in the United States because of FDA approval for treatment of hydatid disease and neurocysticercosis. Decreases ATP production in worm, causing energy depletion, immobilization, and, finally, death.

View full drug information

Thiabendazole (Mintezol)

 

Standard treatment of CLM has been topical thiabendazole; however, high rate of relapse is noted. Also, with less common causes due to human nematodes, does not prevent development of systemic illness or eliminate intestinal reservoir. PO thiabendazole is only FDA-approved drug for treatment of CLM. Therapy with PO formulation has been fraught with adverse effects.

View full drug information

Mebendazole (Vermox)

 

Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.

Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Coauthor(s)

Jining Wang, MD  Department of Dermatology, Dean Health System

Jining Wang, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Kim Wang, MD  Staff Physician, Department of Pathology, Northwestern University Medical School

Kim Wang, MD is a member of the following medical societies: United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael D Nissen, MBBS, FRACP, FRCPA  Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Brenner MA, Patel MB. Cutaneous larva migrans: the creeping eruption. Cutis. Aug 2003;72(2):111-5. [Medline].

  2. Feldmeier H, Schuster A. Mini review: hookworm-related cutaneous larva migrans. Eur J Clin Microbiol Infect Dis. Sep 16 2011;[Medline].

  3. Purdy KS, Langley RG, Webb AN, Walsh N, Haldane D. Cutaneous larva migrans. Lancet. Jun 4 2011;377(9781):1948. [Medline].

  4. Jelinek T, Maiwald H, Nothdurft HD, Loscher 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].

  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. 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].

  7. Black MD, Grove DI, Butcher AR, Warren LJ. Cutaneous larva migrans in infants in the Adelaide Hills. Australas J Dermatol. Nov 2010;51(4):281-4. [Medline].

  8. 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].

  9. Butland RJ, Coulson IH. Pulmonary eosinophilia associated with cutaneous larva migrans. Thorax. Jan 1985;40(1):76-7. [Medline].

  10. Morsy H, Mogensen M, Thomsen J, Thrane L, Andersen PE, Jemec GB. Imaging of cutaneous larva migrans by optical coherence tomography. Travel Med Infect Dis. Jul 2007;5(4):243-6. [Medline].

  11. Veraldi S, Bottini S, Rizzitelli G, Persico MC. One-week therapy with oral albendazole in hookworm-related cutaneous larva migrans: A retrospective study on 78 patients. J Dermatolog Treat. Feb 6 2011;[Medline].

  12. Tan SK, Liu TT. Cutaneous larva migrans complicated by Löffler syndrome. Arch Dermatol. Feb 2010;146(2):210-2. [Medline].

  13. Wright DO, Gold EM. Loeffler's syndrome associated with creeping eruption (cutaneous helminthiasis). Arch Intern Med. 1946;78:303-12.

  14. Burkhart CG, Burkhart CN. Cutaneous larva migrans complicated by erythema multiforme. Cutis. Oct 1998;62(4):170. [Medline].

  15. American Academy of Pediatrics. Cutaneous Larva Migrans. In: Red Book: 2009 Report of the Committee on Infectious Diseases. 28th. Elk Grove Village, IL: American Academy of Pediatrics; 2009:274.

  16. Ang CC. Images in clinical medicine. Cutaneous larva migrans. N Engl J Med. Jan 28 2010;362(4):e10. [Medline].

  17. Ansart S, Perez L, Jaureguiberry S, et al. Spectrum of dermatoses in 165 travelers returning from the tropics with skin diseases. Am J Trop Med Hyg. Jan 2007;76(1):184-6. [Medline].

  18. Cutaneous Larva Migrans. In: Spector JM, Gibson TE. Atlas of Pediatrics in the Tropics and Resource-Limited Settings. Elk Grove Village, IL: American Academy of Pediatrics; 2009:69-71.

  19. Berlin JM, Goldberg SJ, McDonough RD, Leeman DR. JAAD Grand Rounds quiz. Serpiginous eruption on the leg. J Am Acad Dermatol. Nov 2010;63(5):921-2. [Medline].

  20. Bouchaud O, Houze S, Schiemann R, et al. Cutaneous larva migrans in travelers: a prospective study, with assessment of therapy with ivermectin. Clin Infect Dis. Aug 2000;31(2):493-8. [Medline].

  21. Caumes E. It's time to distinguish the sign 'creeping eruption' from the syndrome 'cutaneous larva migrans'. Dermatology. 2006;213(3):179-81. [Medline].

  22. Caumes E, Carriere J, Datry A, et al. A randomized trial of ivermectin versus albendazole for the treatment of cutaneous larva migrans. Am J Trop Med Hyg. Nov 1993;49(5):641-4. [Medline].

  23. Cayce KA, Scott CM, Phillips CM, Frederick C, Park HK. What is your diagnosis? Cutaneous larva migrans. Cutis. Jun 2007;79(6):429, 435-6. [Medline].

  24. Chaudhry AZ, Longworth DL. Cutaneous manifestations of intestinal helminthic infections. Dermatol Clin. Apr 1989;7(2):275-90. [Medline].

  25. Craythorne EE, Wong S, Jones RM, du Vivier AW. A characteristic rash. BMJ. May 20 2009;338:b1451. [Medline].

  26. Cutaneous larva migrans in American tourists. Martinique and Mexico. MMWR Morb Mortal Wkly Rep. Jul 3 1981;30(25):308, 313. [Medline].

  27. Davies HD, Sakuls P, Keystone JS. Creeping eruption. A review of clinical presentation and management of 60 cases presenting to a tropical disease unit. Arch Dermatol. May 1993;129(5):588-91. [Medline].

  28. 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].

  29. Elsner E, Thewes M, Worret WI. Cutaneous larva migrans detected by epiluminescent microscopy [letter]. Acta Derm Venereol. Nov 1997;77(6):487-8. [Medline].

  30. Feldmeier H, Heukelbach J. Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues. Bull World Health Organ. Feb 2009;87(2):152-9. [Medline].

  31. Fleischer LM, Cataldo R, Syed SS. Visual diagnosis: a 10-year-old boy who has a pruritic rash after travel. Pediatr Rev. Nov 2008;29(11):407-9. [Medline].

  32. Ghosh SK, Bandyopadhyay D. Dermacase: Can you identify this condition? Cutaneous larva migrans. Can Fam Physician. May 2009;55(5):489, 491. [Medline].

  33. Grassi A, Angelo C, Grosso MG, Paradisi M. Perianal cutaneous larva migrans in a child. Pediatr Dermatol. Sep-Oct 1998;15(5):367-9. [Medline].

  34. Hardin TF Jr. Management of cutaneous larva migrans in pediatric practice: report on 200 cases. J Am Osteopath Assoc. May 1969;68(9):970-2. [Medline].

  35. Herbinger KH, Siess C, Nothdurft HD, von Sonnenburg F, Löscher T. Skin disorders among travellers returning from tropical and non-tropical countries consulting a travel medicine clinic. Trop Med Int Health. Jul 18 2011;[Medline].

  36. Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis. May 2008;8(5):302-9. [Medline].

  37. Heukelbach J, Hengge UR. Bed bugs, leeches and hookworm larvae in the skin. Clin Dermatol. May-Jun 2009;27(3):285-90. [Medline].

  38. Hotez PJ, Brooker S, Bethony JM, et al. Hookworm infection. N Engl J Med. Aug 19 2004;351(8):799-807. [Medline].

  39. Jensenius M, Maeland A, Brubakk O. Extensive hookworm-related cutaneous larva migrans in Norwegian travellers to the tropics. Travel Med Infect Dis. Jan-Mar 2008;6(1-2):45-7. [Medline].

  40. Kahn G, Johnson JA. Serum IGE levels in cutaneous Larva Migrans. Int J Dermatol. Jul-Sep 1971;10(3):201-3. [Medline].

  41. Kaminska-Winciorek G, Pierzchala E, Brzezinska-Wcislo L. Cutaneous larva migrans syndrome: clinical and ultrasonographic picture of the skin lesions. Eur J Dermatol. May-Jun 2007;17(3):246-7. [Medline].

  42. Kelkar R. Cutaneous larva migrans in England: a case in a returning traveller. Emerg Med J. Sep 2007;24(9):678. [Medline].

  43. Kienast A, Bialek R, Hoeger PH. Cutaneous larva migrans in northern Germany. Eur J Pediatr. Jan 10 2007;[Medline].

  44. Kim TH, Lee BS, Sohn WM. Three clinical cases of cutaneous larva migrans. Korean J Parasitol. Jun 2006;44(2):145-9. [Medline].

  45. Lederman ER, Weld LH, Elyazar IR, et al. Dermatologic conditions of the ill returned traveler: an analysis from the GeoSentinel Surveillance Network. Int J Infect Dis. Nov 2008;12(6):593-602. [Medline].

  46. Lee AC, Schantz PM, Kazacos KR, Montgomery SP, Bowman DD. Epidemiologic and zoonotic aspects of ascarid infections in dogs and cats. Trends Parasitol. Apr 2010;26(4):155-61. [Medline].

  47. Lemery J. Images in emergency medicine. Cutaneous larvae migrans. Ann Emerg Med. Jul 2008;52(1):82, 92. [Medline].

  48. Lesniak R. Cutaneous larva migrans. Dermatol Nurs. Dec 2008;20(6):471-2. [Medline].

  49. Loughrey MB, Irvine AD, Girdwood RW, McMillan JC. Cutaneous larva migrans: the case for routine oral treatment [letter]. Br J Dermatol. Jul 1997;137(1):155-6. [Medline].

  50. Mattone-Volpe F. Cutaneous larva migrans infection in the pediatric foot. A review and two case reports. J Am Podiatr Med Assoc. May 1998;88(5):228-31. [Medline].

  51. Micantonio T, Peris K. What is your call?: pruritic, serpiginous eruption in a returning traveller. CMAJ. Jul 1 2008;179(1):51-2. [Medline].

  52. Monsel G, Caumes E. Recent developments in dermatological syndromes in returning travelers. Curr Opin Infect Dis. Oct 2008;21(5):495-9. [Medline].

  53. Morrone A, Franco G, Fazio R, Valenzano M, Calcaterra R. Bullous cutaneous larva migrans. Acta Dermatovenerol Croat. Jun 2011;19(2):120-1. [Medline].

  54. Novak KD, Williams SM, Kokot I, Schultze RL. Nd:YAG photodestruction of a presumed corneal Toxocara canis larva. Cornea. Jun 2010;29(6):703-5. [Medline].

  55. O'Brien BM. A practical approach to common skin problems in returning travellers. Travel Med Infect Dis. May 2009;7(3):125-46. [Medline].

  56. O'Quinn JC, Dushin R. Cutaneous larva migrans: case report with current recommendations for treatment. J Am Podiatr Med Assoc. May-Jun 2005;95(3):291-4. [Medline].

  57. Ottesen EA, Campbell WC. Ivermectin in human medicine. J Antimicrob Chemother. Aug 1994;34(2):195-203. [Medline].

  58. Outbreak of cutaneous larva migrans at a children's camp--Miami, Florida, 2006. MMWR Morb Mortal Wkly Rep. Dec 14 2007;56(49):1285-7. [Medline].

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

  60. Puente Puente S, Bru Gorraiz F, Azuara Solis M, et al. [Cutaneous larva migrans: 34 outside cases]. Rev Clin Esp. Dec 2004;204(12):636-9. [Medline].

  61. Rao R, Prabhu S, Sripathi H. Cutaneous larva migrans of the genitalia. Indian J Dermatol Venereol Leprol. Jul-Aug 2007;73(4):270-1. [Medline].

  62. Reavis M, Jorgensen S. Acute pruritic rash on the foot. Cutaneous larva migrans. Am Fam Physician. Jan 15 2010;81(2):203. [Medline].

  63. Rizzitelli G, Scarabelli G, Veraldi S. Albendazole: a new therapeutic regimen in cutaneous larva migrans. Int J Dermatol. Sep 1997;36(9):700-3. [Medline].

  64. Rubinsky-Elefant G, Hirata CE, Yamamoto JH, Ferreira MU. Human toxocariasis: diagnosis, worldwide seroprevalences and clinical expression of the systemic and ocular forms. Ann Trop Med Parasitol. Jan 2010;104(1):3-23. [Medline].

  65. Sanchez Fernandez I, Julia Manresa M, Gonzalez Ensenat MA, Vicente Villa MA. Picture of the month--quiz case. Bullous cutaneous larva migrans. Arch Pediatr Adolesc Med. May 2008;162(5):485-6. [Medline].

  66. Senba Y, Tsuda K, Maruyama H, Kurokawa I, Mizutani H, Taniguchi Y. Case of creeping disease treated with ivermectin. J Dermatol. Feb 2009;36(2):86-9. [Medline].

  67. Shih PY, Hsieh MY, Huang YH, Kuo TT. Multiple pruritic erythematous papules on the trunk after a trip to Thailand--quiz case. Arch Dermatol. May 2010;146(5):557-62. [Medline].

  68. Shinkar RM, Stocks R, Thomas E. Cutaneous larva migrans, creeping eruption, sand worm. Arch Dis Child. Oct 2005;90(10):998. [Medline].

  69. Siriez JY, Angoulvant F, Buffet P, Cleophax C, Bourrat E. Individual variability of the cutaneous larva migrans (CLM) incubation period. Pediatr Dermatol. Mar 1 2010;27(2):211-2. [Medline].

  70. Stoicescu RM, Mihai CM, Giannakopoulou AD. Marked hypereosinophilia in a toddler: a case report. J Med Life. Jan-Mar 2011;4(1):105-8. [Medline]. [Full Text].

  71. The Medical Letter. Drugs for Parasitic Infections. Medical Letter On Drugs and Therapeutics. Available at http://secure.medicalletter.org/TG-article-89b.

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

  73. Vaughan TK, English JC 3rd. Cutaneous larva migrans complicated by erythema multiforme. Cutis. Jul 1998;62(1):33-5. [Medline].

  74. Veraldi S, Rizzitelli G. Effectiveness of a new therapeutic regimen with albendazole in cutaneous larva migrans. Eur J Dermatol. Jul-Aug 1999;9(5):352-3. [Medline].

  75. Yap FB. Creeping eruption. Int J Infect Dis. Jun 2010;14(6):e545. [Medline].

 
Previous
Next
 
Cutaneous larva migrans involving the foot with erythematous, edematous, serpiginous tracks. Infestation has caused a cellulitis.
Cutaneous larva migrans involving the dorsal foot. Graphic courtesy of Dr Sara K. Ward.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.