DISCUSSION
DISCUSSIONCutaneous larva migrans is a serpiginous cutaneous
eruption caused by the accidental penetration and migration of
animal hookworm larvae through the epidermis. The infection has a
worldwide distribution and occurs most frequently in warmer
climates. The skin lesions are usually
self-limitedDEFINITIONReference: Bolognia JL, Jorizzo JL, Rapini
RP. Dermatology. 2 ed. USA: Elsevier Limited; 2008, page
1406Cutaneous larva migrans is caused by the larvae of hookworms
that infect domestic dogs and cats (Ancylostoma caninum, A.
braziliense and Uncinaria stenocephala). The infection is usually
acquired by walking barefoot on groundcontaminated with animal
feces, but other body sites can become infected via contact with
contaminated soil or sand. The larvae enter the skin and begin a
prolonged process of migration within the
epidermis.ETIOLOGYReference: Bolognia JL, Jorizzo JL, Rapini RP.
Dermatology. 2 ed. USA: Elsevier Limited; 2008, page 1406Humans are
aberrant, dead-end hosts who acquire the parasite from environment
contaminated with animal feces.Larvae remain viable in soil or sand
for several weeks.Larvae penetrate human skin (e.g. walking
barefoot), and migrate within the epidermis up to several
centimeters a day. More commonly, cavities left by the parasite are
located within the stratum corneum and are associated with
spongiosis.Parasite induces localized eosinophilic inflammatory
reaction with edema, spongiosis, and vesicle formation.Most larvae
are unable to develop further or invade deeper tissues and die
after days or months.PATHOGENESISReference: Klaus Wolff MD, Richard
Allen, Arturo P., Fitzpatricks Color Atlas and Synopsis Of Clinical
Dermatology, 7th ed. USA General Medicine Mc Graw Hill
2013.Patients have intense localized pruritus that begins shortly
after the hookworm penetrates the skin. Several days later, the
pruritus is associated with small vesicles and/or one or more
edematous, serpiginous tracts. Each larva produces one tract and
migrates at a rate of 1 to 2 cm per day. This is commonly the feet,
hands and buttocks. Due to intense pruritus and scratching,
superimposed bacterial infections may complicate the clinical
picture. Vesicles and bullae may develop in previously sensitized
patientsCLINICAL MANISFESTATIONSReference: Bolognia JL, Jorizzo JL,
Rapini RP. Dermatology. 2 ed. USA: Elsevier Limited; 2008, page
1406
Reference: Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. 2
ed. USA: Elsevier Limited; 2008, page 1406Cutaneous larva migrans:
dorsum of foot: A serpiginous, linear, raised, tunnel-like
erythematous lesion outlining the path of migration of the
larva.Cutaneous larva migrans of the buttocks. Hematology:
Peripheral eosinophilia.Dermatopathology: Part of the parasite can
be seen on biopsy specimens from the advancing point of the
lesion(s).LABORATORIUM FINDINGSReference: Klaus Wolff MD, Richard
Allen, Arturo P., Fitzpatricks Color Atlas and Synopsis Of Clinical
Dermatology, 7th ed. USA General Medicine Mc Graw Hill 2013.Larva
currens caused byStrongyloides stercoralisJelly fish stingAllergic
contact dermatitisErythema migrans of Lyme borreliosis DIFFERENTIAL
DIAGNOSISReference: Bolognia JL, Jorizzo JL, Rapini RP.
Dermatology. 2 ed. USA: Elsevier Limited; 2008, page 1406
Larva currens caused byStrongyloides stercoralis. Erythematous,
edematous urticarial lesions in the back and the abdomen.
Jellyfish sting. Erythematous macules and papules appear and may
develop into pustules or vesicles. It is quite pruritic.Reference:
Klaus Wolff MD, Richard Allen, Arturo P., Fitzpatricks Color Atlas
and Synopsis Of Clinical Dermatology, 7th ed. USA General Medicine
Mc Graw Hill 2013.Erythema migrans of Lyme borreliosis
Allergic contact dermatitis.
Reference: William D James, Timothy G Berger, Dirk M Elston;
Andrews Diseases OF THE Skin Clinical Dermatology, Eleventh
EditionBoth albendazole (400 mg po daily for 3 days) and ivermectin
(200 g/kg daily for 1 or 2 days) are effective. Treatment of
hookworm folliculitis may require repeated treatments. Topical
therapy with thiabendazole or 10% albendazole may also be used.
Because larvae have usually migrated beyond the end of the visible
skin lesion and their location cannot be reliably determined,
surgical excision or cryotherapy are not
recommended.TREATMENTReference: Goldsmith LA, Katz SI, Gilchrest
BA. Fitzpatrick's Dermatology in General Medicine. 8 ed. USA: The
McGraw-Hill Companies, Inc; 2012, page 2560
