Cutaneous Larva Migrans

Cutaneous larva migrans (CLM) is skin infection caused by hookwork. This is most commonly transmitted by animal feces depositing eggs in the soil, with larvae entering humans through direct contact with skin. However larvae can't penetrate the basal membrane of the skin to enter lymphatic system. Therefore, hookworms can't complete their life cycle (CLM is self-limited).

CLM is a clinical manifestation demonstrated by creeping migration of larva through the skin (creeping eruption). The most common initial finding is a small reddish papule that progresses to a serpiginous pruritic rash with a slow rate of progression from less than 1 to 2 cm per day.

                                   

The disease is self-limited. However, for local infection use topical thiabendazole 15% ointment (as first line) applied 2 to 3 times daily for 5 to 10 days. Small studies have shown improvement of pruritus may occur as early as 48 hours after beginning treatment, and cure rates as high as 98% within ten days have been achieved. The largest advantage of topical therapy is a lack of systemic absorption and side effects.

For multiple lesions or severe infestation, albendazole and ivermectin are first-line systemic therapies. Oral albendazole, 400 mg daily for 3 to 5 days, is very effective with cure rates nearing 100%. Some studies show that a 7-day course of albendazole may decrease the rates of recurrent disease. Oral ivermectin is also effective, and its advantage is a patient only has to take a one-time dose of 12 mg by mouth. Cure rates near 100% with ivermectin administration.

Reference 

Maxfield, L. & Crane, J. S., 2020, StatPearls : Cutaneous larva migrans, Treasure Island.