Cutaneous larva migrans

From WikiProjectMed
Jump to navigation Jump to search
Cutaneous larva migrans
Other names: Dew itch, [1]CLM
  • Top:Cutaneous larva migrans

  • Bottom: Life cycle[2]
SpecialtyInfectious disease
SymptomsBlisters,itching, snakelike tracks in the skin [3]
ComplicationsSecondary infection, secondary impetiginization[4]
CausesAncylostoma duodenale and Necator americanus[4]
Diagnostic methodVisual inspection/recent travel[4]
Differential diagnosisScabies,Loiasis,Myiasis,Schistosomiasis,Tinea corporis, Contact dermatitis,Fascioliasis,Phytophotodermatitis[4]
TreatmentTopical thiabendazole 10% solution(or 15% ointment)[4]
FrequencyPrevalent in United States, Latin America, the Caribbean, Southeast Asia[4]

Cutaneous larva migrans (abbreviated CLM) is a skin disease in humans, caused by the larvae of various nematode parasites of the hookworm family (Ancylostomatidae).[5] These parasites live in the intestines of dogs, cats, and wild animals and should not be confused with other members of the hookworm family for which humans are definitive hosts, namely Ancylostoma duodenale and Necator americanus.[4]

Colloquially called creeping eruption due to its presentation, the disease is also somewhat ambiguously known as ground itch or (in some parts of the southern USA) "sandworms", as the larvae like to live in sandy soil. Another vernacular name is plumber's itch. The medical term CLM literally means "wandering larvae in the skin".[6][7][4]

CLM can be treated via a number of different ways including systemic agents such as albendazole.[6]

Symptoms and signs

The infection causes a red, intensely pruritic (itchy) eruption, and may look like twirling lesions.[4]

The itching can become very painful and if scratched may allow a secondary bacterial infection to develop. Cutaneous larva migrans usually heals spontaneously over weeks to months and has been known to last as long as one year.[8]

However, the severity of the symptoms usually causes those infected to seek medical treatment before spontaneous resolution occurs.[6]

  • Cutaneous larva migrans(inside lateral part of the foot)
    Cutaneous larva migrans(inside lateral part of the foot)
  • Cutaneous larva migrans(sole of the foot)
    Cutaneous larva migrans(sole of the foot)
  • Cutaneous larva migrans(outside lateral part of the foot)
    Cutaneous larva migrans(outside lateral part of the foot)

Complications

Among the complications that Cutaneous larva have are the following:[4]

Cause

Ancylostoma duodenale

The etiology of Cutaneous larva migrans is due to :[4]

  • Ancylostoma braziliense
  • Ancylostoma caninum
  • Uncinaria stenocephala
  • Ancylostoma duodenale
  • Necator americanus

Transmission

Hookworm eggs are shed in the infected dog (or other animal) feces to the ground and beach sand, where they then develop over a period of 1–2 weeks into the infectious larval form (filariform larvae).[9] The filariform larvae can burrow through intact skin that comes into contact with soil or sand that is contaminated with feces. Although they are able to infect the deeper tissues of animals (through to the lungs and then the intestinal tract), humans are incidental hosts and the larvae are only able to penetrate the epidermis of the skin[6] and thus create the typical wormlike burrows visible underneath the skin. These parasites apparently lack the collagenase enzymes required to penetrate through the basement membrane deeper into the dermal layers of the skin.[4]

Diagnosis

The evaluation of Cutaneous larva migrans can be done via visual inspection and sometimes using skin biopsy in the affected individual[3]

Differential diagnosis

Tinea corporis

The DDx of Cutaneous larva migrans is as follows(this is separate from the similar cutaneous larva currens which is caused by Strongyloides. Larva currens is also a cause of migratory pruritic eruptions but is marked by 1) migratory speed on the order of inches per hour 2) perianal involvement due to autoinfection from stool and 3) a wide band of urticaria.[10]):[4]

Treatment

Albendazole

CLM can be treated in an affected individual via a number of different ways:

  • Systemic (oral) agents include albendazole[6][7] (Albenza)[11] and ivermectin[6] (Stromectol).[12]
  • Another agent which can be applied either topically or taken by mouth is thiabendazole[6][7] (Mintezol),[13] an anti-helminthic.
  • Topical freezing agents, such as ethylene chloride or liquid nitrogen,[6] applied locally can freeze and kill the larvae, but this method has a high failure rate because the larvae are usually located away from the site of the visible skin trails. Additionally, this is a painful method which can cause blistering and/or ulceration of the skin and it is therefore not recommended.[6]
  • It is recommended to use some anti-itch cream (i.e. Cortizone or Calamine lotion). This will help relieve some of the itch, but is not a remedy[14]
  • Wearing shoes in areas where these parasites are known to be endemic offers protection from infection.[6] In general, avoiding exposure of skin to contaminated soil or sand offers the best protection[6]

Epidemiology

In terms of epidemiology we find that CLM has a worldwide distribution, but it is most prevalent in tropical and subtropical regions.Travelers to regions like Africa, South America, Asia, and the Caribbean are at higher risk.[15]

History

The discovery of Cutaneous larva migrans was first described as "CLM" by Lee in 1874. Later, in 1893, Crocker coined the term "Cutaneous larva migrans". The parasitic nature of the condition was further established by Hammelstjerna in 1896[16][17]

See also

References

  1. ↑ "Cutaneous larva migrans (Concept Id: C0546999) - MedGen - NCBI". www.ncbi.nlm.nih.gov. Retrieved 12 March 2025.
  2. ↑ "CDC - DPDx - Zoonotic Hookworm". www.cdc.gov. 17 September 2019. Retrieved 14 April 2025.
  3. ↑ 3.0 3.1 "Creeping eruption: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 14 March 2025.
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 Maxfield, Luke; Crane, Jonathan S. (2025). "Cutaneous Larva Migrans". StatPearls. StatPearls Publishing. PMID 29939528. Archived from the original on 2021-08-29. Retrieved 2025-03-12.
  5. ↑ Morris-Jones, Rachel (2019). "117. Insect bites and infestations". In Morris-Jones, Rachael (ed.). ABC of Dermatology (7th ed.). Hoboken: Wiley Blackwell. p. 145. ISBN 978-1-119-48899-6. Archived from the original on 2023-07-18. Retrieved 2023-07-15.
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 Caumes, E. (1 May 2000). "Treatment of Cutaneous Larva Migrans". Clinical Infectious Diseases. 30 (5): 811–814. doi:10.1086/313787. PMID 10816151.
  7. ↑ 7.0 7.1 7.2 Albanese, G; Caterina Venturi; Giuseppe Galbiati (2001). "Treatment of larva migrans cutanea (creeping eruption): a comparison between albendazole and traditional therapy". International Journal of Dermatology. 40 (1): 67–71. doi:10.1046/j.1365-4362.2001.01103.x. PMID 11277961.
  8. ↑ Chaudhry, AZ; Lonworth DL (1989). "Cutaneous manifestations of intestinal helminthic infections". Dermatol Clin. 7 (2): 275–90. doi:10.1016/S0733-8635(18)30599-0. PMID 2670373.
  9. ↑ CDC. "Parasites". Archived from the original on 2 May 2021. Retrieved 25 April 2013.
  10. ↑ ARTHUR, ROBERT P. (1 August 1958). "Larva Currens". AMA Archives of Dermatology. 78 (2): 186–90. doi:10.1001/archderm.1958.01560080044007. PMID 13558704.
  11. ↑ Drugs.com. "Albenza". Drugs.com. Archived from the original on 14 October 2012. Retrieved 25 April 2013.
  12. ↑ Drugs.com. "Stromectol". Drugs.com. Archived from the original on 7 January 2012. Retrieved 25 April 2013.
  13. ↑ Drugs.com. "Mintezol". Drugs.com. Archived from the original on 13 October 2012. Retrieved 25 April 2013.
  14. ↑ Osman, Solafa; Tarnari, Nectaria; Ahsan, Areeba; Ahmed, Khabab Abbasher Hussien Mohamed (1 April 2024). "Cutaneous Larva Migrans (CLM) may not be easy to diagnose: a case report and narrative review". Oxford Medical Case Reports. 2024 (4): omae025. doi:10.1093/omcr/omae025. PMC 11049579. PMID 38680772.
  15. ↑ "Cutaneous Larva Migrans | CDC Yellow Book 2024". wwwnc.cdc.gov. Archived from the original on 2025-03-01. Retrieved 2025-03-17.
  16. ↑ Beaver, Paul C. (1959). "Visceral and Cutaneous Larva Migrans". Public Health Reports (1896-1970). 74 (4): 328–332. doi:10.2307/4590442. ISSN 0094-6214. JSTOR 4590442. PMC 1929226. PMID 13645880. Archived from the original on 8 June 2023. Retrieved 16 March 2025.
  17. ↑ Karthikeyan, Kaliaperumal; Thappa, Devinder Mohan (1 September 2002). "Cutaneous larva migrans". Indian Journal of Dermatology, Venereology and Leprology. 68: 252. ISSN 0378-6323.

External links

Classification
External resources
Retrieved from "https://mdwiki.org/w/index.php?title=Cutaneous_larva_migrans&oldid=1466076"