Cutaneous larva migrans

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Cutaneous larva migrans

Weronika Szczecinska and Anthony Abdullah

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports

Management strategy

The systemic treatment normally used by the authors for patients over the age of 2 years is oral albendazole 400 mg daily for 3 days. An alternative is ivermectin given as a single dose of 12 mg orally (or 200 µg/kg) for adults and children older than 5 years or more than 15 kg in weight. Topical treatment usually takes the form of thiabendazole in a suitable lipophilic vehicle.

Specific investigations

Clinical appearance is characteristic.

First-line therapies

Systemic albendazole	B
Systemic ivermectin	B

One-week therapy with oral albendazole in hookworm-related cutaneous larva migrans: a retrospective study on 78 patients.

Veraldi S, Bottini S, Rizzitelli G, Persico MC. J Dermatolog Treat 2012; 23: 189–91.

Seventy-eight patients with multiple and/or extensive lesions of Hr-CLM were treated with albendazole 400 mg/day for 1 week. Cure rate was 100% at 3 months’ follow-up. The disappearance of pruritus was reported after 2 to 3 days and skin lesions after 5 to 7 days of therapy. The authors concluded that this regimen was very effective and had no severe side effects.

Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning traveler.

Blackwell V, Vega-Lopez F. Br J Dermatol 2001; 145: 434–7.

Thirty-one patients received oral albendazole 400 mg daily for 3 to 5 days and 24 were cured (77%). Five patients received 10% thiabendazole cream topically for 10 days and four were cured (80%). There were no reported side effects. Four patients needed no treatment.

A randomized trial of ivermectin versus albendazole for the treatment of cutaneous larva migrans.

Caumes E, Carriere J, Datry A, Gaxotte P, Danis M, Gentilini M. Am J Trop Med Hyg 1993; 49: 641–4.

A comparison of efficacy between oral ivermectin (12 mg) and oral albendazole (400 mg). Twenty-one patients were randomly assigned to receive ivermectin (n=10) or albendazole (n=11). All patients who received ivermectin responded and none relapsed (cure rate 100%). All except one patient in the group receiving albendazole responded, but five relapsed after a mean of 11 days (cure rate 46%; p=0.017). No major adverse effects were observed. The authors suggest that a single dose of ivermectin is more effective than a single dose of albendazole.

Cutaneous larva migrans in travelers: a prospective study, with assessment of therapy with ivermectin.

Bouchaud O, Houze S, Schiemann R, Durand R, Ralaimazava P, Ruggeri C, et al. Clin Infect Dis 2000; 31: 493–8.

Sixty-four patients were studied. The cure rate after a single dose of 200 µg/kg ivermectin was 77%. One or two supplementary doses were necessary for 14 patients. The overall cure rate was 97%. No systemic adverse effects were reported. Single-dose ivermectin therapy appears to be effective and well tolerated. Several treatments might be required.

Treatment of cutaneous larva migrans.

Van den Enden E, Stevens A, Van Gompel A. N Engl J Med 1998; 339: 1246–7.

Fifty-one patients who had one or more Hr-CLM lesions received a single oral dose of 12 mg ivermectin. The lesions in 48 patients (94%) healed within 5 days. There were no side effects. Two patients relapsed, but were cured within 2 days after a second dose of ivermectin. One patient had repeated relapses, notwithstanding additional treatments, possibly related to concurrent immunosuppressive therapy.

Treatment of 18 children with scabies or cutaneous larva migrans using ivermectin.

Del Mar Saez-De-Ocariz M, McKinster CD, Orozco-Covarrubias L, Tamayo-Sánchez L, Ruiz-Maldonado R. Clin Exp Dermatol 2002; 27: 264–7.

A report of 18 children aged 14 months to 17 years, of which seven had Hr-CLM. All seven were cured with a single dose of 150–200 µg/kg ivermectin, with no significant adverse effects. In the authors’ experience ivermectin is a safe and effective alternative treatment for cutaneous parasitosis in children.

Second-line therapies

Topical thiabendazole in a lipophilic vehicle

Efficacy and tolerability of thiabendazole in a lipophil vehicle for cutaneous larva migrans.

Chatel G, Scolari C, Gulletta M, Casalini C, Carosi G. Arch Dermatol 2000; 136: 1174–5.

Six patients were treated twice daily for 5 days with topical applications of 15% thiabendazole ointment in a lipophilic vehicle of base fat cream (24 g) and dimethyl sulfoxide gel (35 g). The ointment was prepared by crushing the tablets of thiabendazole in the lipophilic base. All patients experienced a clinical resolution within a median of 48 hours. No adverse effects and no recurrence had occurred in any patient at 3 months’ follow-up.

Treatment with topical thiabendazole ointment at 10–15% concentration in a hydrophilic vehicle has shown 98% efficacy within a median of 10 days of treatment.

Third-line therapies

Topical albendazole	E
Cryotherapy	E

Efficacy of albendazole ointment on cutaneous larva migrans in 2 young children.

Caumes E. Clin Infect Dis 2004; 38: 1647–8.

Two 2-year-old patients were treated with a 10% albendazole ointment, prepared by crushing three 400 mg tablets of albendazole in 12 g of petroleum jelly. Treatment was applied three times daily for 10 days. The cutaneous lesions disappeared within a week. One patient had recurrence at 3 months and the lesion disappeared within a week after repeated treatment. The author suggests that albendazole ointment is a safe and effective treatment for Hr-CLM in children.

Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans.

Heukelbach J, Feldmeier H. Lancet Infect Dis 2008; 8: 302–9.

Cryotherapy is ineffective, painful, and may cause ulcerations.

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Cutaneous larva migrans

Weronika Szczecinska and Anthony Abdullah

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports

Management strategy

Specific investigations

Clinical appearance is characteristic.

First-line therapies

Systemic albendazole	B
Systemic ivermectin	B

One-week therapy with oral albendazole in hookworm-related cutaneous larva migrans: a retrospective study on 78 patients.

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Cutaneous larva migrans

Cutaneous larva migrans

Management strategy

Specific investigations

First-line therapies

One-week therapy with oral albendazole in hookworm-related cutaneous larva migrans: a retrospective study on 78 patients.

Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning traveler.

A randomized trial of ivermectin versus albendazole for the treatment of cutaneous larva migrans.

Cutaneous larva migrans in travelers: a prospective study, with assessment of therapy with ivermectin.

Treatment of cutaneous larva migrans.

Treatment of 18 children with scabies or cutaneous larva migrans using ivermectin.

Second-line therapies

Efficacy and tolerability of thiabendazole in a lipophil vehicle for cutaneous larva migrans.

Third-line therapies

Efficacy of albendazole ointment on cutaneous larva migrans in 2 young children.

Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans.

Cutaneous larva migrans

Management strategy

Specific investigations

First-line therapies

One-week therapy with oral albendazole in hookworm-related cutaneous larva migrans: a retrospective study on 78 patients.