Cutaneous Larva Migran

Creeping Eruption — a skin infestation caused by the migration of hookworm larvae through the epidermis

Aetiology

  • Common causative organisms:
    • Ancylostoma braziliense (most common)
    • Ancylostoma caninum
    • Occasionally Uncinaria stenocephala
  • Transmitted through skin contact with contaminated soil or sand containing hookworm larvae.
  • Risk environments:
    • Beaches
    • Sandboxes
    • Moist soil contaminated with animal feces

Pathophysiology

  1. Filariform larvae penetrate intact skin.
  1. Larvae migrate within the epidermis, unable to penetrate deeper tissues.
  1. This migration forms serpiginous, erythematous tracks.
  1. Host immune response → intense pruritus and inflammation.
Larval movement rate: ~2–3 mm per day.

Clinical presentation

  • Intensely pruritic, serpiginous, raised, erythematous tracks
  • “Creeping” or snake-like pattern (serpigeneous), advancing over time
  • Papules or vesicles at entry site
notion image
  • Most common sites:
    • Feet
    • Buttocks
    • Thighs
    • Hands (areas contacting contaminated ground)
  • Secondary infection may occur due to scratching.

Investigations

  • Primarily clinical based on characteristic skin lesions
  • History of travel or exposure to beaches/soil
  • Lab tests usually unnecessary
  • No routine visualization of larvae on microscopy

Management

First-line Treatments:
  • Albendazole
    • 400 mg orally once daily for 3–5 days
  • Ivermectin
    • 200 µg/kg orally as a single dose (repeat next day if needed)
Alternative:
  • Topical thiabendazole 10–15% (for localized lesions)
Symptomatic relief:
  • Antihistamines for pruritus
  • Topical corticosteroids for inflammation
  • Treat secondary infection if present
Most cases resolve within weeks even without treatment, but therapy accelerates healing and reduces itching.