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Cutaneous Larva Migrans

(Creeping Eruption)

by James G. H. Dinulos, MD

Cutaneous larva migrans is a hookworm infection transmitted from warm, moist soil or sand to exposed skin.

Cutaneous larva migrans is caused by Ancylostoma, a hookworm that normally inhabits the intestines of dogs and cats. The eggs of the parasite are in dog and cat feces and develop into larvae when left in warm, moist soil or sand. When bare skin touches the ground, for example, when a person walks barefoot or sunbathes, the hookworm gets into the skin. Cutaneous larva migrans occurs worldwide but is most common in tropical environments.

Starting from the site of infection—usually the feet, legs, buttocks, or back—the hookworm burrows along a haphazard tract, leaving a winding, threadlike, raised, reddish brown rash. The rash itches intensely.

Doctors base the diagnosis on the appearance and location of the rash and on the person's history of recent contact with soil or sand.

A liquid or cream preparation of thiabendazole applied to the affected area effectively treats the infection. Albendazole or ivermectin given by mouth also is effective.

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