Cutaneous Larva Migrans

Cutaneous Larva Migrans – General Information

The Cutaneous Larva Migrans (also known as “creeping eruption”, “sandworms” or “ground itch” and also abbreviated CLM) is a skin disease encountered in humans, which is caused by the larvae of some of the nematode parasites (the most common nematode parasite is Ancylostoma braziliense).
Researchers have found these parasites also in cats and dogs feces, but if in these animals they are able to affect their deeper tissues through their lungs and intestinal tract, in humans they can penetrate only the outer layer of the skin, leading to visible wormlike burrows under the skin. Because the parasites can not penetrate the deeper tissues, the researcher discovered that the parasites lack the collagenase enzyme which is needed in order to penetrate the basement membrane (which is localized deep into the skin). There is not a predisposition for this disease; people of all ages, race and sex can be at any time affected if they have been exposed to the parasites. The parasites usually are encountered in the tropical and subtropical geographic areas. People who are at a risk of getting infected with Cutaneous Larva Migrans are those who get in contact with warm, sandy and moist soil. These can include: farmers, gardeners, plumbers, hunters, carpenters, electricians, pest exterminators, children who play in the sandpits and sunbathers. After an animal passes the feces which are infested with this parasite’s eggs, the eggs hatch into larvae which can penetrate the human skin. These larvae are mostly found in sandy areas or in shaded, moist sand.

Cutaneous Larva Migrans – Symptoms

It is well known the fact that any medical disorder (including Cutaneous Larva Migrans) can trigger a variety of symptoms. Therefore, some of this medical condition's most uncommon symptoms have not been listed (mentioned) here. This is why we strongly recommend you to contact your personal health care provider whenever you develop any unusual, bothersome or unpleasant symptoms. Your personal physician will be able to tell you if you are suffering from Cutaneous Larva Migrans or from any other medical disorder. Here is a list of the most common symptoms that a person who suffers from Cutaneous Larva Migrans, may experience: tingling or prickling sensation after half an hour from the moment of the penetration, red elevation of the skin in the affected area (also known as papule)-which appear in a few hours after the penetration and usually develop in the areas who were in contact with the soil such as hands, buttocks and feet. The larvae begin to migrate underneath the skin leading to the appearance of itchy, red, lines which can be accompanied by blisters. This process can take from a few days to several months. Other symptoms, which infected patients may experience, are the followings: anemia, cough, pneumonia, itchy rash, pruritis, pain, itchiness, local swelling, snake-like track underneath the skin, fever,– but this does not appear in all of the cases -, vesicles with serous fluid, peripheral eosinophilia, elevated levels of immunoglobulin, pneumonitis, myotis, severe eosinophilic enteritis (inflammation of the small intestine).

Cutaneous Larva Migrans – Treatment

The Cutaneous Larva Migrans is usually diagnosed by a physician. The physician can do a microscopic inspection which is usually utilized in ordered to reveal the worm’s eggs or the larvae which exist in the feces or stool. In the majority of the cases a biopsy accompanied or not by a cryosurgery is not necessary, because they do not show the migrating parasites and can even aggravate the local inflammation.
            The Cutaneous Larva Migrans can be treated in different ways, such as:

• Systemic (also known as oral) agents, that include ivermicin and albendazole; or a topical agent that can be taken orally (but causes nausea, dizziness, vomiting, and other side effects when it is taken orally) too, is thiabendazole.
• Topical freezing agents that include: liquid nitrogen and ethyl chloride can be applied locally in order to freeze and kill the larvae.

If the Cutaneous Larva Migrans is left untreated, the larvae die in the epidermis after a few weeks, because they are not able to finish their lifecycles in the human hosts. If the doctor prescribes an ivermectin based treatment, then the patient should take only one dose of this drug a day, until the improvements are visible. The secondary infections which can appear from the pruritis can be treated with antibacterial ointments like Bactroban.

The patients who do not have intestinal symptoms do not require treatment, as the worms will die or will be excreted. In the cases in which the patients have mild infections, these can be treated by applying one of the drugs directly on the skin along the snake-tracks and the areas around them. The good news is that no matter how severe the infection is, if treated the patients can recover completely. Other drugs which a doctor may prescribe to the patients who are suffering from Cutaneous Larva Migrans are the following:

Albenza tablets – this drug works by not letting the worms to absorb sugar, making the worms to loose energy and die; Mintezol chewable tablets; Stromectol tablets – is a drug used in treating certain worm infections. It is an anthelmintic which works by killing the parasites; albendazole – is a drug used in treating certain worm infections. It is an anthelmintic which works by killing the parasites; Ivermectin – is a drug used in treating certain worm infections; Mintezol – it is an anthelmintic which works by killing the parasites; Mintezol suspension – it is an anthelmintic which works by killing the parasites; Stromectol – is a drug used in treating certain worm infections. It is an anthelmintic which works by killing the parasites; Thiabendazole suspension - is a drug used in treating certain worm infections. It is an anthelmintic which works by killing the parasites. It may also be used in treating other medical condition.
The Cutaneous Larva Migrans can be prevented, by avoiding the skin contact with the moist soil which is contaminated with animal feces, by wearing adequate footwear when going to the beach, by prohibiting the entrance of dogs and cats on the beach, and by having a good hygiene.