Published on 18/03/2015 by admin
Filed under Dermatology
Last modified 22/04/2025
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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
Hookworm-related cutaneous larva migrans (Hr-CLM) is a disease caused by percutaneous penetration and migration of animal hookworm larvae in the human skin, most commonly Ancylostoma braziliense, Ancylostoma caninum, Uncinaria stenocephala and Bunostonum phlebotomum. People at risk are the inhabitants and returning travellers from tropical and subtropical countries, and children playing in sandpits. Incubation period can vary between a few days to 7 months after exposure to contaminated soil or sand. The clinical picture is that of characteristic ‘creeping eruption’ with serpiginous, papular, vesiculobullous, and erythematous lesions due to the presence of moving parasites. The common sites involved are the feet, buttocks and thighs. Rare complications include pulmonary eosinophilic infiltrates, hookworm folliculitis and oral mucosal lesions.
Hookworm-related cutaneous larva migrans is self-limiting: most lesions resolve within 2 to 8 weeks because the human is a ‘dead-end host’. However, the lesions are extremely pruritic, can be extensive and can significantly reduce the quality of life, so treatment is often required.
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.
Clinical appearance is characteristic.
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.
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.
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.
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.
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.
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.
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.
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.
Heukelbach J, Feldmeier H. Lancet Infect Dis 2008; 8: 302–9.
Cryotherapy is ineffective, painful, and may cause ulcerations.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Systemic albendazole
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Topical thiabendazole in a lipophilic vehicle
Topical albendazole
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