Review Article

Cutaneous Larva
Migrans
By. Nuraga Dwi P. AND Riska Siela S.
 Introduction
What is CLM?

Creeping eruption,
sandworm disease, beach
worm disease, ground itch,
linear serpiginous dermatitis,
dermatitis serpiginosus,
migrant helminthiasis,
migrant linear epidermatitis,
epidermatitis linearis
migrans, creeping verminous
dermatitis, duck hunter's
itch, and plumber's itch
 Introduction
Pruritic erythematous migrating tortuous or serpiginous,
Clinically
slightly raised track.

Hookworm-related cutaneous larva migrans is the most

Causes
common cause of a creeping eruption

One of the most common skin diseases reported

CLM intravelers returning from tropical regions

Western physicians, however, are often not

familiar of this condition
 Epidemiology
Tropical & Subtropical regions,
especially developing countries

10% of dermatological diagnoses in sick

travelers returning from tropical region

CLM Rainy Season  15 times higher

ENDEMIC
Central and South America, Mexico,
Caribbean, Africa, Southeast Asia,
Mediterranean regions, the southeastern
parts of the United States

No racial or sex predilection

Child >> Adult
 CAUSATIVE ORGANISMS

Ancylostoma braziliense

Uncinaria stenocephala
Bunostomum phlebotomum
Ancylostoma ceylonicum Ancylostoma caninum
DISEASE TRANSMISSION
AND PATHOPHYSIOLOGY
 CLINICAL MANIFESTATIONS

 A stinging or tingling sensation

(30 minutes of the larva
penetrating the skin)

 Itchy reddish-brown papule or

nonspecific eruption

 Formation of an
erythematous, slightly raised,
tortuous, winding, serpiginous
or, less often, linear track
extending from the reddish-
brown papule
 DIAGNOSIS
 The diagnosis is mainly clinical

 Based on the history of travel to an endemic area and

exposure to contaminated soil/sand and the
characteristic serpiginous track.
 DIAGNOSTIC STUDIES

 Dermoscopy (shows
translucent, brownish,
structureless areas)

 Near-infrared
fluorescence imaging

 Confocal scanning
laser microscopy
 DIFFERENTIAL DIAGNOSIS

 Larva currens  Dracunculiasis

(strongyloidiasis)
 Tungiasis
 Migratory (creeping)
 Scabies
myiasis
 Herpes zoster
 Loiasis
 Tinea corporis
 Cercarial dermatitis
 Contact dermatitis
 Gnathostomiasis
 Bacterial folliculitis
 Dirofilariasis
 COMPLICATIONS
RARELY

 Sleep disturbance  Optic disease edema

 Secondary bacterial  Löffler syndrome
infection
 Eczematization
 Localized and/or
generalized allergic
reactions
 PROGNOSIS
 The prognosis is excellent

 The disease is selflimited and usually resolves in weeks

to months even without treatment

 Rarely, the larva may persist in the hair follicle for up to

two years
 MANAGEMENT
Oral Topical
Antihelmentic Antihelmentic Cryotherapy
Agents Agents

Oral Ivermectin Topical Albendazole

Fractional
Carbon
Oral Albendazole Topical Thiabendazole Dioxide Laser
Oral Thiabendazole

Miscellaneous
 PREVENTION
 Preventative measures include periodic deworming of
dogs and cats and banning them from beaches and
playgrounds

 Disposing the waste products of dogs and cats properly

 Wearing proper footwear while walking on the beach

 Using towels, mattresses and deckchairs on the beach,

and avoiding lying or sitting directly on the sand/soil