Pediatric Cutaneous Larva Migrans Clinical Presentation

Updated: May 23, 2018
  • Author: Martha L Muller, MD, MPH; Chief Editor: Russell W Steele, MD  more...
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The patient with cutaneous larva migrans (CLM) may recall a stinging sensation upon initial penetration of the larvae.

An erythematous papule or a nonspecific dermatitis can develop hours after penetration.

The most common location for penetration is the feet (39%), from walking barefoot in the sand, followed by the buttocks (18%) and the abdomen (16%).



The migration of the larvae produces a 2-mm to 4-mm wide, erythematous, elevated, vesicular serpiginous track. Vesiculobullous and papular lesions may be observed in association with the linear track.

Migration of the larvae through the skin occurs from a week to several months after initial penetration, depending on the type of roundworm. The rate of larval migration is from 2 mm to 2 cm per day, depending on the species of larva. Unlike in animals, the larvae are unable to penetrate the epidermal basement membrane of human skin; therefore, the larvae roam haphazardly in the epidermis and are unable to complete their life cycle.

An allergic immune response of the patient to the larvae or byproducts causes the pruritic erythematous track. The actual location of the larvae is usually 1-2 cm beyond the erythematous track.

Untreated lesions resolve after the larvae die (ie, within weeks to months).



The most common cause of CLM is Ancylostoma braziliense, which is a dog and cat hookworm found in the United States, Central America, South America, and the Caribbean. [12]

Other reported, less common, animal roundworms that cause CLM include the following:

  • Ancylostoma tubaeforme, Ancylostoma caninum, Ancylostoma ceylanicum, and Uncinaria stenocephala (ie, dog hookworms)

  • Bunostomum phlebotomum (ie, cattle hookworm)

  • Gnathostoma species (ie, cat, dog, and pig roundworms)

  • Capillaria species (ie, whipworms found in rodents, cats, dogs, and poultry)

  • Strongyloides myopotami, Strongyloides papillosus, and Strongyloides westeri (found in the small intestine of mammals)

  • Nematodes that use a human as a definitive host, such as Ancylostoma duodenale, Strongyloides stercoralis, and Necator americanus (rare causes of CLM): A duodenale and N americanus usually cause ground itch. S stercoralis is usually associated with larva currens.

CLM should not be confused with visceral larva migrans and ocular larva migrans, which are due to the ingestion of the eggs of the parasite Toxocara canis or Toxocara cati. Children with pica or people eating unwashed raw vegetables have the greatest risk of acquiring visceral and ocular larva migrans.

The following individuals are at risk of infection with CLM:

  • Sunbathers

  • Fishermen

  • Hunters

  • Gardeners

  • Construction workers

  • Pest exterminators

  • Children

  • Anyone with skin contact to sand or soil in warm areas