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Cutaneous Larva Migrans

(Creeping Eruption)


James G. H. Dinulos

, MD, Geisel School of Medicine at Dartmouth

Reviewed/Revised Dec 2021 | Modified Sep 2022
Topic Resources

Cutaneous larva migrans is the skin manifestation of hookworm infestation.

Cutaneous larva migrans is caused by Ancylostoma species, 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. Cutaneous larva migrans occurs worldwide but most commonly in tropical environments.

Cutaneous larva migrans causes intense pruritus; signs are erythema and papules at the site of entry, followed by a winding, threadlike subcutaneous trail of reddish brown inflammation. Patients may also develop papules and vesicles resembling folliculitis Folliculitis Folliculitis is an infection of hair follicles. Diagnosis is clinical. Treatment for most cases of bacterial folliculitis is with topical mupirocin or clindamycin. (See also Overview of Bacterial... read more Folliculitis , called hookworm folliculitis. Diagnosis of cutaneous larva migrans is by history and clinical appearance.

Although the infection resolves spontaneously after a few weeks, discomfort and the risk of secondary bacterial infection warrant treatment. Topical thiabendazole 15% liquid or cream (compounded) applied 2 to 3 times a day for 5 days is extremely effective. Oral thiabendazole is not well tolerated and not usually used. Albendazole (400 mg orally once a day for 3 to 7 days) and ivermectin (200 mcg/kg orally once a day for 1 to 2 days) can cure the infestation and are well tolerated. Topical albendazole 10% ointment (compounded) applied 3 times a day for 10 days is effective.

General reference

  • 1. Podder I, Chandra S, Gharami RC: Loeffler's syndrome following cutaneous larva migrans: An uncommon sequel. Indian J Dermatol 61(2):190–192, 2016. doi: 10.4103/0019-5154.177753

Drugs Mentioned In This Article

Drug Name Select Trade
Sklice, Soolantra, Stromectol
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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