Cutaneous Larva Migrans

Cutaneous Larva Migrans is a tropical disease that is commonly found in the foot.  It is the result of an infection with one of a variety of hookworms, including the species Ancylostoma braziliense (cat hookworm) and Ancylostoma caninum (dog hookworm).  These parasites are typically seen in tropical or subtropical environments such as the Caribbean, Mexico, Brazil, Souteast Asia, and Africa.  Humans can pick these up as an accidental end-organism from walking barefoot on the beach, or in other areas of the body from contact. 

The skin lesions are extremely itchy, and can cause great discomfort for those affected.  The migrating line that is characteristic of the infection is caused by the path that the organism takes underneath the skin.  The parasite can actually be several centimeters ahead of the trailing line, as the reaction is delayed.  The lesion that forms is linear, typically in a winding pattern, red, and raised from the skin. 

Rarely, the lesions along the body may also contain small pustules.  These are formed from the parasite becoming trapped within the sebaceous glands.  Small, pimple-like lesions may occur.  This may complicate the condition, as these small lesions may erupt and become infected secondarily.  This complication, however, is rare.

Diagnosis of cutaneous larva migrans is made through clinical examination.  A history of travel to tropical or subtropical environments is common in those affected.  X-rays and other imaging studies are not necessary for the diagnosis.

The infection is self-limiting, as humans are only an accidental host for the parasite.  The hookworm will usually die with two weeks of infection. 

Treatment for cutaneous larva migrans is with oral ivermectin, an anthelmintic drug.  Treatment with a single dose is usually curative, and has rarely induced side effects.  Albendazole has also been used orally.  This drug is usually administered over three to five days, and has a similar curative rate as ivermectin.  Topical thiabendazole has also been used.  A biopsy of the skin one to two centimeters ahead of the lesion may reveal the parasite. 

 While it may seem like a creepy, crawly problem, the condition is ultimately benign.  In the vast majority of cases, cutaneous larva migrans resolves without complication, even without treatment.  If you find new lesions on your feet or any other part of your body that are painful or itchy, be sure to point them out to your doctor.   While cutaneous larva migrans may not be the most serious of diagnoses, this creepy problem may just make you want to wear sandals on your next vacation!

Central Florida Foot & Ankle Center, LLC 
101 6th Street N.W. 
Winter Haven, FL 33881 
863-299-4551 
www.FLFootandAnkle.com