Medical Care

Even though cutaneous larva migrans (CLM) is self-limited, the intense pruritus and risk for infection mandate treatment. Prevention is key and involves avoidance of direct skin contact with fecally contaminated soil.

Oral albendazole, oral ivermectin, or topical ivermectin are the usual treatment choices,^{[18, 19, 20]}along with perhaps thiabendazole (not available in the United States).^[21]

In the United States, albendazole at 400 mg/day for 3 days is recommended. Alternatively, ivermectin can be administered as a 12-mg dose and repeated the next day. Some also recommend trying topical treatment with topical ivermectin or topical thiabendazole compounded in a 10% suspension or 15% cream or topical metronidazole cream, all used four times daily. If effective, the topical therapies are expected to resolve the condition in 1 week.

Outside the United States, thiabendazole has been recommended for the treatment of cutaneous larva migrans, as has oral albendazole or ivermectin.^[21]Thiabendazole is not available in the United States.

Consultations

Consultation with a dermatologist may be warranted.

Medication

Edelglass JW, Douglass MC, Stiefler R, Tessler M. Cutaneous larva migrans in northern climates. A souvenir of your dream vacation. J Am Acad Dermatol. 1982 Sep. 7(3):353-8. [QxMD MEDLINE Link].
Herbener D, Borak J. Cutaneous larva migrans in northern climates. Am J Emerg Med. 1988 Sep. 6(5):462-4. [QxMD MEDLINE Link].
Jones WB 2nd. Cutaneous larva migrans. South Med J. 1993 Nov. 86(11):1311-3. [QxMD MEDLINE Link].
Patel S, Sethi A. Imported tropical diseases. Dermatol Ther. 2009 Nov-Dec. 22(6):538-49. [QxMD MEDLINE Link].
Tamminga N, Bierman WF, de Vries PJ. Cutaneous larva migrans acquired in Brittany, France. Emerg Infect Dis. 2009 Nov. 15(11):1856-8. [QxMD MEDLINE Link].
González F CG, Galilea O NM, Pizarro C K. [Autochthonous cutaneous larva migrans in Chile. A case report]. Rev Chil Pediatr. 2015 Oct 8. [QxMD MEDLINE Link].
Vega-Lopez F, Hay RJ. Parasitic worms and Protozoa. Burns T, Breathnach S, Cox N, Griffiths C, eds. Rook's Textbook of Dermatology. 8th ed. United Kingdom: Wiley-Blackwell Publisher (P) Ltd; 2010. 37.16–37.17.
Veraldi S, Persico MC, Francia C, Schianchi R. Chronic hookworm-related cutaneous larva migrans. Int J Infect Dis. 2013 Apr. 17 (4):e277-9. [QxMD MEDLINE Link].
Bowman DD, Montgomery SP, Zajac AM, Eberhard ML, Kazacos KR. Hookworms of dogs and cats as agents of cutaneous larva migrans. Trends Parasitol. 2010 Apr. 26(4):162-7. [QxMD MEDLINE Link].
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. 2011 Nov. 5(11):e1355. [QxMD MEDLINE Link]. [Full Text].
Jones CC, Rosen T, Greenberg C. Cutaneous larva migrans due to Pelodera strongyloides. Cutis. 1991 Aug. 48(2):123-6. [QxMD MEDLINE Link].
Reichert F, Pilger D, Schuster A, Lesshafft H, Guedes de Oliveira S, Ignatius R, et al. Prevalence and Risk Factors of Hookworm-Related Cutaneous Larva Migrans (HrCLM) in a Resource-Poor Community in Manaus, Brazil. PLoS Negl Trop Dis. 2016 Mar. 10 (3):e0004514. [QxMD MEDLINE Link].
Sunderkötter C, von Stebut E, Schöfer H, Mempel M, Reinel D, Wolf G, et al. S1 guideline diagnosis and therapy of cutaneous larva migrans (creeping disease). J Dtsch Dermatol Ges. 2014 Jan. 12 (1):86-91. [QxMD MEDLINE Link].
Archer M. Late presentation of cutaneous larva migrans: a case report. Cases J. 2009 Aug 12. 2:7553. [QxMD MEDLINE Link]. [Full Text].
Podder I, Chandra S, Gharami RC. Loeffler's Syndrome Following Cutaneous Larva Migrans: An Uncommon Sequel. Indian J Dermatol. 2016 Mar-Apr. 61 (2):190-2. [QxMD MEDLINE Link].
Meotti CD, Plates G, Nogueira LL, Silva RA, Paolini KS, Nunes EM, et al. Cutaneous larva migrans on the scalp: atypical presentation of a common disease. An Bras Dermatol. 2014 Mar-Apr. 89 (2):332-3. [QxMD MEDLINE Link].
Aljasser MI, Lui H, Zeng H, Zhou Y. Dermoscopy and near-infrared fluorescence imaging of cutaneous larva migrans. Photodermatol Photoimmunol Photomed. 2013 Dec. 29 (6):337-8. [QxMD MEDLINE Link].
Veraldi S, Angileri L, Parducci BA, Nazzaro G. Treatment of hookworm-related cutaneous larva migrans with topical ivermectin. J Dermatolog Treat. 2017 May. 28 (3):263. [QxMD MEDLINE Link].
Hombu A, Yoshida A, Kikuchi T, Nagayasu E, Kuroki M, Maruyama H. Treatment of larva migrans syndrome with long-term administration of albendazole. J Microbiol Immunol Infect. 2017 Jul 14. [QxMD MEDLINE Link].
Leung AK, Barankin B, Hon KL. Cutaneous larva migrans. Recent Pat Inflamm Allergy Drug Discov. 2017 Jan 10. [QxMD MEDLINE Link].
Kincaid L, Klowak M, Klowak S, Boggild AK. Management of imported cutaneous larva migrans: A case series and mini-review. Travel Med Infect Dis. 2015 Sep-Oct. 13 (5):382-7. [QxMD MEDLINE Link].
Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology. St. Louis, Mo: Mosby; 2003. 1307-09.

Media Gallery

A patient who was sunbathing nude on a beach in Martinique presented with classic erythematous, serpiginous tracts on the left heel.
Cutaneous larva migrans on the right thumb.
Cutaneous larva migrans on the left thigh.

of 3

Author

David T Robles, MD, PhD, FAAD Dermatologist, Oak Tree Dermatology

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

Disclosure: Nothing to disclose.

Coauthor(s)

Jacquiline Habashy, DO, MSc Resident Physician, Department of Dermatology, Western University of Health Sciences College of Osteopathic Medicine of the Pacific

Jacquiline Habashy, DO, 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 Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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 Women's Association, Phi Beta Kappa

Disclosure: Nothing to disclose.