Cutaneous Larva Migrans

Cutaneous larva migrans also called as creeping eruption or sand worm occurs when canine hookworm penetrate the skin and start moving through the superficial layer of the skin (epidermis). It is one of the most common skin diseases among the travelers returning from tropical countries.

Cutaneous larva migrans is most commonly seen in the sole of the foot. In few cases, it can also be seen on thigh, buttocks and the back that may have come in contact with the soil or sand contaminated with animal feces.

As the larva lacks certain enzymes that are necessary to penetrate the deeper dermis, they keep wandering randomly creating a route in a snake-like pattern. They can borrow at the rate of around 2 cm per day. The humans are actually the accidental host, so it’s the dead-end for the larva. Unable to find their way into the circulation they die in about 2 to 8 weeks.

Who is at risk?

People of all races, ages and sex can be affected by sand worm or cutaneous larva migrans. People living or travelling around tropical or subtropical region are the most groups at risk. These may include:

• Travelling around tropical and subtropical region
• Occupations and hobbies that involve skin contact with soil and sand.
• Beach loving, sunbathers
• Plumber, farmers, hunters and gardeners
• Children in sandboxes
• Pest exterminator

Signs and Symptoms of Cutaneous Larva Migrans

The lesion are very classical with a distinct serpiginous borrows created by the larva. When combined with the recent history of possible exposure, the diagnosis is clear. The lesion may be itchy and red. Symptom starts to show up within first 2 weeks of the individual’s return from endemic or tropical areas. Lesion may sometimes be mistaken for fungal infection or other inflammatory disorders. So, it is wise to visit a dermatologist if in confusion.

Treatment of Cutaneous Larva Migrans

As the human are accidental and dead-end host, the larva can’t survive in the epidermis and eventually dies after 2-8 weeks. If untreated, the lesion will resolve in 4-8 weeks. However, there are several effective treatments which can shorten the disease course.

Old therapies like freezing the edge of the skin burrow by liquid nitrogen, solid CO2 or ethylene rarely works, as larva is usually located few centimeters beyond the visible end of the burrow. Anthelmintics drugs like albendazole and tiabendazole are effective against the cutaneous larva migrans. For early, localized and mild lesions, topical 10%-15% thiabendazole is considered the treatment of choice, as it has advantage of no systemic side effects. Although not approved by FDA, Ivermectin is another good choice and is effective with just a single dose.

If in case of any secondary infection, antibiotics may be needed. After initiation of medication itching will be reduced within 24-48 hours and the track created by larva resolves within 7-10 days.

How to prevent Cutaneous Larva Migrans

Cutaneous larva migrans can be easily prevented with some measures listed below:

• Avoid skin contact with the soil or sand contaminated with animal feces.
• Always wear enough footwear and use cloth barrier or mattress when sitting or lying on the beach or ground.
• Always avoid lying on dry sand, even on a towel.