Published on 18/03/2015 by admin
Filed under Dermatology
Last modified 18/03/2015
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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.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Systemic albendazole
Systemic ivermectin
