Overview

Cutaneous Larva Migrans is a skin condition caused by tiny worm larvae that burrow just beneath the surface of your skin, creating itchy, winding tracks. It's often called "creeping eruption" because the rash appears to slowly move or "creep" across the skin.

This condition is caused by the larvae of hookworms that usually live in the intestines of animals like dogs and cats. These larvae are passed into the environment through animal feces and can contaminate soil or sand. People typically get it when their bare skin comes into contact with this contaminated ground, especially in warm, moist climates. It's common in children playing in sandboxes, beachgoers, gardeners, and travelers to tropical or subtropical regions.

It's important to know that Cutaneous Larva Migrans is not contagious from person to person. You get it from the environment. Living with this condition can be quite uncomfortable due to the intense itching, which can sometimes affect sleep and daily activities.

Symptoms

You might experience several symptoms if you have Cutaneous Larva Migrans. The most common ones include:

• An intensely itchy rash, - which is often the first and most bothersome symptom. The itching can feel worse at night.
• Visible, raised, winding, or snake-like reddish-brown tracks or lines - under the skin. These tracks are usually 1-2 millimeters wide and can lengthen by a few millimeters to a few centimeters each day as the larva moves.
• The rash most commonly appears on areas of the body that have touched contaminated ground, such as the feet, legs, buttocks, or hands.
• Small bumps or blisters - may sometimes appear along these tracks.
• You might feel a tingling or stinging sensation - at the site where the larva entered the skin, even before the rash becomes visible.
• Symptoms usually develop a few days after exposure to the larvae, but it can sometimes take a week or more.
• Scratching the itchy areas can lead to skin irritation, open sores, and redness.

Diagnosis

Diagnosing Cutaneous Larva Migrans is usually straightforward for a healthcare professional.

• A doctor can often diagnose it simply by looking at the characteristic appearance of the rash - those unique winding tracks – and by talking with you about your recent activities. They'll likely ask if you've recently traveled to a warm climate, walked barefoot on a beach, or had contact with soil or sandboxes.
• In most cases, no special tests are needed. On very rare occasions, if the diagnosis isn't clear, a doctor might consider taking a tiny skin sample (a biopsy) to look for the larva, but this is seldom necessary as the larva itself is difficult to find.

Management & Treatment

Dealing with the constant itch of Cutaneous Larva Migrans can be very frustrating, but there are excellent treatments available to speed up your recovery and provide relief.

The infection will go away on its own over several weeks to months because the larvae can't survive indefinitely in your skin. However, most people seek treatment to get rid of the uncomfortable symptoms faster and reduce the risk of other problems.

• Prescription Medications: The most effective way to treat the infection is with anti-parasitic medications prescribed by a doctor.
  • Oral Medications: Pills like ivermectin or albendazole are the most common treatments. They work throughout your body to kill the larvae and are very effective, often requiring only a few doses.
  • Topical Medications: For very small, localized infections, a cream or ointment containing thiabendazole may be prescribed to apply directly to the skin.
• Symptom Relief: The itching should start to get much better within a day or two of starting treatment. Your doctor might also suggest an antihistamine to help manage the itch while the medication starts to work.
• Home Care: It's very important to avoid scratching the rash. Breaking the skin can lead to a secondary bacterial infection. Keep the area clean and dry. If you notice increased redness, swelling, or pus, you should see your doctor, as you may need an antibiotic ointment.
• What to Avoid: An older treatment involved freezing the area (cryotherapy), but this is no longer recommended. It is painful and often doesn't work because the larva has already moved beyond the visible end of the track.

If you think you have Cutaneous Larva Migrans, seeing a healthcare professional is the best way to get an accurate diagnosis and a prescription that will bring you relief quickly.

Duration & Outlook

The good news is that Cutaneous Larva Migrans is usually a self-limiting condition.

• The hookworm larvae that cause this rash in humans cannot complete their life cycle in our bodies. This means they will eventually die on their own, typically within several weeks to a few months (often 4-8 weeks).
• It is considered an acute condition, meaning it's temporary and not a long-term chronic illness.
• You can expect the rash and itching to resolve completely. The main concern during this time is managing the discomfort from itching and preventing any secondary bacterial infections that could occur from scratching the skin too much.
• Warning signs for complications include increased redness, warmth, swelling around the rash, pus, or if you develop a fever. These could be signs of a bacterial skin infection, and if you notice them, it's important to see a doctor.

Prevention

Preventing Cutaneous Larva Migrans is all about avoiding contact with contaminated soil or sand. Here are some simple steps you can take:

• Wear shoes or sandals, - especially when walking on beaches, sandy areas, or soil where animals may have been.
• When relaxing on the beach or ground, use a towel or mat - to create a barrier between your skin and the sand or soil.
• Try to avoid sitting or lying directly on sand - in areas where animals, particularly stray dogs or cats, are known to roam.
• If you have a sandbox at home for your children, keep it covered when not in use - to prevent animals from defecating in it.
• If you have pets, ensure they are regularly dewormed - as recommended by your veterinarian. This helps reduce the number of hookworm eggs shed into the environment.

Causes & Triggers

Understanding what causes Cutaneous Larva Migrans can help you avoid it.

• It's caused by the larvae of animal hookworms. - The most common types are Ancylostoma braziliense (found in dogs and cats) and Ancylostoma caninum (found in dogs).
• These larvae are present in the feces of infected animals. When these feces contaminate soil or sand, especially in warm, moist conditions, the larvae can hatch and survive.
• Human infection occurs when bare skin comes into direct contact with this contaminated ground, - and the larvae penetrate the skin. They can't develop further in humans, so they wander under the skin, causing the characteristic rash.
• Common triggers include:
  • Walking barefoot on beaches or in sandy areas.
  • Sitting or lying directly on contaminated soil or sand.
  • Children playing in uncovered sandboxes.
  • Gardening or working with soil without protective gloves or footwear in endemic areas.
• People most likely to develop it include:
  • Travelers to tropical and subtropical regions (like the Caribbean, Southeast Asia, South America, and parts of the southern United States).
  • Children, due to their play habits involving direct contact with sand and soil.
  • Beachgoers and sunbathers.
  • Individuals whose occupations involve contact with soil, such as gardeners, plumbers, electricians, and construction workers in affected regions.
• Risk factors - include any activity that involves prolonged skin exposure to potentially contaminated soil or sand in areas where animal hookworms are common.

When to see a doctor

While Cutaneous Larva Migrans often resolves on its own, it's wise to seek medical advice in certain situations. We care about you getting the right diagnosis and relief.

• You should consider seeing a doctor if you notice a distinctive, winding, itchy rash, - especially if you've recently been in an environment where exposure is possible (like a beach or sandbox).
• It's particularly important to consult a healthcare professional if:
  • The itching is severe - and causing significant distress or disrupting your sleep.
  • The rash seems to be spreading rapidly - or involves a large area of skin.
  • You notice signs of a possible skin infection - from scratching. Look for increased pain, swelling, redness that spreads, warmth to the touch around the rash, pus draining from the area, or if you develop a fever.
  • You are unsure what is causing your skin issue, - as other conditions can sometimes look similar.
• A doctor or a dermatologist (a doctor specializing in skin conditions) can confirm if you have Cutaneous Larva Migrans. Even though the condition is self-limiting, they can offer advice and sometimes prescribe medication to help relieve the intense itching and discomfort, and to manage any secondary infections if they occur. Getting a clear diagnosis can also bring peace of mind.

Frequently Asked Questions (FAQs):

• Q: Can I get Cutaneous Larva Migrans directly from petting my dog or cat?
  A: No, you typically don't get it directly from petting your dog or cat. The infection comes from contact with soil or sand that has been contaminated with the feces of an infected animal, where the hookworm larvae are living. This is why regular deworming of pets is so important to help protect everyone.
• Q: Will Cutaneous Larva Migrans go away on its own?
  A: Yes, in humans, the larvae cannot mature or reproduce. They will eventually die, and the rash and itching typically resolve on their own, usually within several weeks to a couple of months. However, the itching can be very intense during this period, and we understand how frustrating that can be.
• Q: Is Cutaneous Larva Migrans dangerous?
  A: Generally, Cutaneous Larva Migrans is not considered dangerous. The larvae stay within the outer layers of the skin and eventually die off. The main concerns are the severe itching, which can be very uncomfortable, and the possibility of a secondary bacterial skin infection if the skin is broken from too much scratching.
• Q: If I scratch the rash, can it spread to other parts of my body?
  A: The rash itself doesn't spread to new areas simply because you scratch it. The "spreading" appearance of the track is due to the larva moving under your skin. However, scratching can damage the skin, making it raw and open to bacterial infection, which might make the affected area look worse or become more inflamed.
• Q: I’m pregnant. If I get Cutaneous Larva Migrans, is there a risk to my baby?
  A: The hookworm larvae that cause Cutaneous Larva Migrans stay within the skin and do not typically enter the bloodstream or internal organs in humans. Therefore, they are unlikely to pose a direct risk to an unborn baby. However, any skin condition or infection causing significant discomfort during pregnancy should always be discussed with your doctor to ensure you receive the best care.
• Q: Can children get this condition more easily?
  A: Children can be more susceptible simply because they often play in sand and soil, such as in sandboxes or on beaches, and may be less likely to wear shoes or use towels consistently. It's important to supervise their play in these areas and encourage good hygiene.

References

• Centers for Disease Control and Prevention. (2023, August 28). CDC - Cutaneous Larva Migrans. Retrieved from https://www.cdc.gov/parasites/zoonotichookworm/health_professionals/index.html
• American Academy of Dermatology Association. (n.d.). Hookworm-related infection: Cutaneous larva migrans. Retrieved from https://www.aad.org/public/diseases/a-z/cutaneous-larva-migrans