Cutaneous larva migrans (CLM, also creeping eruption) is the skin manifestation of hookworm infestation.
CLM is caused by Ancylostoma sp, most commonly dog or cat hookworm Ancylostoma braziliense. Hookworm ova in dog or cat feces develop into infective larvae when left in warm moist ground or sand; transmission occurs when skin directly contacts contaminated soil or sand and larvae penetrate unprotected skin, usually of the feet, legs, buttocks, or back. CLM occurs worldwide but most commonly in tropical environments.
CLM causes intense pruritus; signs are erythema and papules at the site of entry, with a winding, threadlike subcutaneous trail of reddish-brown inflammation. Diagnosis is by history and clinical appearance.
Topical thiabendazole 15% liquid or cream (compounded) bid to tid for 5 days is extremely effective. Oral thiabendazole is not well tolerated and not usually used. Albendazole (400 mg po once/day for 3 to 7 days) and ivermectin (200 mcg/kg for 1 to 2 days) can cure the infestation and are well tolerated.
CLM may be complicated by a self-limiting pulmonary reaction called Löffler syndrome (patchy pulmonary infiltrates and peripheral blood eosinophilia).
Last full review/revision March 2013 by James G. H. Dinulos, MD