A-Z OF SKIN

Cutaneous Larva Migrans

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Last updated: March 2024

Also known as: Creeping Eruption, Sand-worm Eruption or Plumber’s Itch

What is cutaneous larva migrans?

Cutaneous larva migrans is an itchy localised skin infestation caused by the penetration and migration of animal hookworm larvae through the skin.

Who gets cutaneous larva migrans?

Individuals of all ages, sex and race can be affected by cutaneous larva migrans if they have been exposed to hookworm larvae.

The condition is more common in tropical or subtropical regions such as the northern parts of Australia and tropical Asian countries. Individuals who come into contact with warm, moist, sandy soil infested with animal faeces are most at risk of developing this condition, and may include:

  • barefoot beachgoers and sunbathers,
  • children who play in sandpits.
  • carpenters
  • electricians
  • plumbers
  • farmers
  • gardeners
  • pest exterminators.

What causes cutaneous larva migrans?

The condition is caused by the larvae of hookworms that infect dogs, cats and other animals.

The infection of a human host usually occurs as a result of lying, sitting or walking barefoot on ground contaminated with animal faeces. The condition remains confined to the outer layers of the skin as the larvae are unable to penetrate the basement membrane to invade the deeper layers.

What does cutaneous larva migrans look like?

Affected individuals may have intense localised itch that begins shortly after the hookworm penetrates the skin. Red, swollen lumps, fluid-filled lumps and/or one or more snake-like tracts appear as the condition progresses. Hundreds of such lesions may be found on a single individual.

Non-specific dermatitis, blistering lesions and superimposed bacterial infection may make larva migrans more difficult to diagnose.

The condition most frequently affects the lower extremities, abdomen or buttocks but any exposed site may be affected.

Figure 1. © 2021 Elsevier Inc. All rights reserved. Habif’s Clinical Dermatology. A Color Guide to Diagnosis and Therapy. SEVENTH EDITION James G.H. Dinulos, MD

How is cutaneous larva migrans diagnosed?

The diagnosis is usually based on a clinical examination of the skin. Skin biopsies are sometimes needed.

How is cutaneous larva migrans treated?

Treatment options will vary depending on the individual and their needs.

Prevention is key, including:

  • Wearing shoes when walking in sandy areas.
  • Lying on sand washed by the tide, or using a mattress or chair on tropical beaches visited by dogs.
  • Avoiding lying on dry sand, even on a towel.

Even though the condition is self-limiting, treatment is available to shorten its course and to alleviate symptoms, and may include:

  • Topical thiabendazole for early, localised lesions to small areas.
  • Oral medications such as anthelmintics (i.e., ivermectin, albendazole, mebendazole).
  • Antibiotics if a bacterial superinfection is present.
  • Antihistamines and topical corticosteroids to help relieve itching.

What is the likely outcome of cutaneous larva migrans?

The condition is self-limiting which means that it resolves spontaneously without treatment. The time taken to resolve varies considerably depending on the species of larvae involved. In most cases, lesions will resolve without treatment within 4 to 8 weeks, but some may persist for many months.

Dr Davin Lim and Dr Heba Jibreal

March 2024

Dr Davin Lim and Dr Heba Jibreal

May 2021

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