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Cutaneous larva migrans (creeping eruption)
Cutaneous larva migrans results when the larvae of the hookworms Ancylostoma braziliense and A. caninum, which are excreted by infected dogs and cats, penetrate intact skin. Other nematode species have also been implicated. The condition is particularly prevalent in Central America, some countries of South America, the Caribbean and the southeastern United States, and throughout tropical Africa. It is characterized by pruritic, winding, thread-like inflammatory lesions, most commonly on the feet.
In most cases, the larvae remain localized, causing only a transient focal dermatitis of varying intensity. They do not mature into adult worms in humans but, occasionally, they migrate to the lungs to cause eosinophilia, cough and pulmonary infiltrates (Loeffler syndrome).
Prevention is directed to interrupting transmission. Regular deworming of dogs and cats reduces contamination of soil and protective footwear reduces the likelihood of contact.
Albendazole administered orally in a single dose of 400 mg cures almost all cases.1 Tiabendazole may also be of value when administered topically twice or three times daily for 7-10 days. Calamine lotion provides symptomatic relief.
1 For further information, see WHO model prescribing information: drugs used in parasitic diseases, 2nd ed. Geneva, World Health Organization, 1995.