Cutaneous larva migrans is caused by migration of larval nematodes through the epidermis.

The migrating worms provoke severe inflammation, which appears as serpinginous urticarial trails.

The names applied to this condition are as varied as the organisms that cause it and include creeping eruptions, sandworm, plumber’s itch, duck hunter’s itch, and epidermis linearis migrans.

The common larval nematodes are Strongyloides stercoralis, Ancylostoma brasiliensis , Ancylostoma caninum, Uncinaria stenocephala, Bunostomum phlebotomum, Necator americanus and Gnathostoma spinigerum.

In a condition known as larva currens (creeping eruption), the agent is Strongyloides stercoralis.

This disorder was first reported in prisoners of war held by the Japanese during Word War II.

Unlike cutaneous larva migrans, linear urticarial trails in the area of the anus are the only lesions.

Dogs and cats infected with hookworm are the major source of the disease.

Outbreaks of cutaneous larva migrans occur at subtropical and tropical beaches.

Plumbers who crawl under houses and animal caretakers are also frequently infected.

The diagnosis is based on history and clinical appearance.

Microscopic features:

- Small cavities in the epidermis (correspond to the track of the larva) ;

- Parasite is rarely seen in the section ;

- Diffuse spongiotic dermatitis ;

- Intraepidermal vesicles containing some eosinophils ;

- Usually no inflammatory reaction around larva ;

- Mixed inflammatory reaction behind the migrating larva with a superficial dermal infiltrate of numerous eosinophils, neutrophils, lymphocytes and plasma cells ;

- Eosinophilic folliculitis may be present.

Thiabendazole is the treatment of choice and is effective in either topical or oral preparations.

Further reading:

Mini review: Hookworm-related cutaneous larva migrans.

Hookworm-related cutaneous larva migrans in northern Brazil: resolution of clinical pathology after a single dose of ivermectin.

A simple intervention to prevent cutaneous larva migrans among devotees of the Nallur Temple in Jaffna, Sri Lanka.

Chronic hookworm-related cutaneous larva migrans.

An unusual presentation of cutaneous larva migrans in a male child.

Cutaneous larva migrans.

Cutaneous larva migrans in Hospital Kuala Lumpur, Malaysia: rate of correct diagnosis made by the referring primary care doctors.

Cutaneous larva migrans: a neglected disease and possible association with the use of long socks.

Larva migrans in the oral mucosa: report of a case.

Cutaneous larva migrans--a case report.

Cutaneous larva migrans, creeping eruption, sand worm.

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Dr Sampurna Roy MD

Consultant Histopathologist (Kolkata - India)