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LETTER TO THE EDITOR  
Year : 2013  |  Volume : 6  |  Issue : 1  |  Page : 139
Cutaneous larva migrans in a nonendemic area


Department of Dermatology, Venereology and Leprosy, Katihar Medical College, Katihar, Bihar, India

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Date of Web Publication18-Jul-2013
 

How to cite this article:
Ganguly S, Jaykar KC, Mallik SK, Jha AK. Cutaneous larva migrans in a nonendemic area. Ann Trop Med Public Health 2013;6:139

How to cite this URL:
Ganguly S, Jaykar KC, Mallik SK, Jha AK. Cutaneous larva migrans in a nonendemic area. Ann Trop Med Public Health [serial online] 2013 [cited 2019 Dec 5];6:139. Available from: http://www.atmph.org/text.asp?2013/6/1/139/115197
Sir,

A 50-year-old male patient presented to the dermatology OPD with complaints of a linear, slightly itchy lesion on the right forearm since the last 4 days. On examination, a long-narrow linear serpiginous plaque was seen on the dorsal aspect of the right forearm just proximal to the wrist. Few vesicles were noted on one end of the lesion. According to the patient the lesion appeared after he removed weeds from a field and it had advanced slightly over the 4 days duration. A diagnosis of cutaneous larva migrans was made and the patient was prescribed oral ivermectin 12 mg in empty stomach, to be repeated after 1 week and oral albendazole 400 mg once daily for 7 days. The patient was completely lesion free after 1 week.

Cutaneous larva migrans, also known as creeping eruption, is infection with a larval nematode that wanders in the subcutaneous tissues. It is endemic in Caribbean islands, Africa, South America, South East Asia, and South-eastern United States. It is most commonly caused by the hookworm that infects dogs and cats. Common causative agents include Ancylostoma braziliense, Ancylostoma caninum, Ancylostoma ceylonicum, Uncinaria stenocephala, Bubostomum phlebotomum, and Strongyloides stercoralis. [1] The parasite's eggs are passed from animal feces into warm, moist soil or sand, where the larvae hatch. Transmission occurs when skin comes in direct contact with contaminated soil or sand. In humans, the larvae are unable to penetrate the basement membrane to invade the dermis, so it remains limited to the epidermis. The main affected areas are the dorsum and sole of the feet (uni and bilateral), buttocks, waist, legs, and shoulders. The main signs and symptoms are linear and/or serpiginous lesions (which progress from 2-3 mm to 2-3 cm per day) with pruritus. Topical thiabendazole has been found to be effective in killing the larvae and alleviating symptoms but requires repeated application, can result in an irritant reaction and is often followed by recurrences. Oral thiabendazole has been reported to have a very high efficacy and is usually given in the dose of 25-50 mg per kg body weight, once or twice daily for 2-5 days. It is not widely used because of unavailability and high incidence of side effects such as nausea, anorexia, headache, and gastrointestinal disturbances. [2] Albendazole is now considered to be the drug of choice for this disorder. It is used in the dosage of 400-800 mg/day for a period that may vary from 1 to 7 days. [3] Ivermectin 200 μg/kg body weight, repeated after 1 week has been found to be useful. The occurrence of this condition in a noncoastal area and involvement of the upper limb are unusual features in this particular case.[Figure 1]
Figure 1: Narrow linear serpiginous eruption

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   References Top

1.Karthikeyan K, Thappa DM. Cutaneous larva migrans. Indian J Dermatol Venereol Leprol 2002;68:252-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis 2008;8:302-9.  Back to cited text no. 2
[PUBMED]    
3.Veraldi S, Rizzitelli G. Effectiveness of a new therapeutic regimen with albendazole in cutaneous larva migrans. Eur J Dermatol 1999;9:352-3.  Back to cited text no. 3
[PUBMED]    

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Correspondence Address:
Satyaki Ganguly
Department of Dermatology, Venereology and Leprosy, Katihar Medical College, P.O. Box No. 23, Katihar, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.115197

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