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Cutaneous Larva Migrans

(Creeping Eruption)


James G. H. Dinulos

, MD, Geisel School of Medicine at Dartmouth

Last full review/revision May 2020| Content last modified May 2020
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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, called hookworm folliculitis. Diagnosis 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) 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.

Cutaneous larva migrans may be complicated by a self-limiting pulmonary reaction called Löffler syndrome (patchy pulmonary infiltrates and peripheral blood eosinophilia; 1).

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.

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