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.
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.
Warm and humid conditions are conducive to hatching infective 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. This includes barefoot beachgoers and sunbathers, tourists and children who play in sandboxes. Occupations at risk include carpenters, electricians, plumbers, farmers, gardeners and pest exterminators.
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 person.
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.
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.
A Color Guide to Diagnosis and Therapy
SEVENTH EDITION James G.H. Dinulos, MD
The diagnosis is usually based on a clinical examination of the skin. Skin biopsies are sometimes needed.
Prevention is the key.
- Wear shoes when walking in sandy areas.
- It is best to lie on sand washed by the tide or use a mattress or chair on tropical beaches visited by dogs.
- Avoid 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.
- Topical treatments
Early lesions localised to small areas may be treated with topical thiabendazole.
- Oral medications
Oral medications such as anthelmintics (e.g. ivermectin, albendazole, mebendazole) can provide a reliable cure.
- Additional treatments
- Antibiotics may be needed if a bacterial superinfection is present
- Antihistamines and topical corticosteroids may be used to help relieve itching.
This information has been written by Dr Davin Lim and Dr Heba Jibreal
