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CASE REPORT

Cutaneous larva migrans in children: A case series

from Southern India
Indira Subhadarshini Paul, Bhagirath Singh1
Department of Paediatrics, Vinayaka Missions Medical College and Hospital, 1Department of Dermatology, Venereology and
Leprosy, Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry, India

ABSTRACT

Cutaneous larva migrans or creeping eruptions is a parasitic skin infection caused by hookworm larva. It is common in
warmer tropical and subtropical countries. Here, we report four patients aged between 7 months and 14 years presented to
outpatient Department of Paediatrics with cutaneous lesions over buttocks, right hand, right foot, and left thigh. Wandering
threadlike progressive lesions were noticed on cutaneous examination, consistent with a diagnosis of cutaneous larva
migrans. Complete resolution seen after treatment with oral albendazole.

Key words: Creeping eruption, cutaneous larva migrans, infant

INTRODUCTION examination reveals no abnormality. Peripheral blood

analysis was normal with no eosinophilia. Fecal analysis

C utaneous larva migrans is characterized by

progressive linear or serpiginous lesions most
commonly seen over the dorsum and soles of the foot.
was negative for parasites. A clinical diagnosis of
cutaneous larva migrans was made.

Tropical climates, overcrowding, poor hygiene, and Case 2

sanitation problems play a very important role in the
causation of this disease.[1] Ancylostoma duodenale also
called “old world hookworm” and Necator americanus also
called “new world hookworm” are the most common
intestinal parasites found to cause creeping eruptions.
CASE REPORTS
Case 1
A 7‑month‑old male child presented to us with 2 weeks
history of the pruritic lesion on the buttocks migrating at
the rate of 2–3 cm/day. No history of fever, cough, or loose
stool. Baby was developmentally normal. Vaccination
was done up to date. On examination revealed a slightly
raised, erythematous, threadlike tract on the buttocks
of size approximately 10 cm length, healing at one end
and progressing at another end [Figure 1]. Systemic
A 6‑year‑old female child referred from primary health
center for evaluation of erythematous, serpentine, pruritic
cutaneous lesion over dorsum right hand [Figure 2]. The
lesion persists for 3 weeks, and the size is progressing
every day. As history noted initially, it was 5 cm in length,
and while presenting to us it was 8 cm in length. There
was a history of walking in barefoot and playing in the
sand. There was no other associated complain. Systemic
examination was normal. Baseline hematological and
biochemical investigations were within normal limits.
Based on history and clinical findings, a diagnosis of
cutaneous larva migrans was made.
ADDRESS FOR CORRESPONDENCE
Dr. Indira Subhadarshini Paul,
Vinayaka Missions Medical College and Hospital,
Karaikal ‑ 609 609, Puducherry, India.
E‑mail: paul_indira20@yahoo.com

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DOI: How to cite this article: Paul IS, Singh B. Cutaneous larva migrans in
10.4103/2319-7250.188454 children: A case series from Southern India. Indian J Paediatr Dermatol
2017;18:36-8.

36 © 2017 Indian Journal of Paediatric Dermatology | Published by Wolters Kluwer - Medknow

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Paul and Singh: Cutaneous larva migrans

Case 3 cutaneous examination, a diagnosis of cutaneous

An 8‑year‑old male child presented to us with a larva migrans was made.
complaint of intensely itchy lesion over the dorsum
and all 4 toes of the right foot except great toe for
3 weeks, for which home remedies were taken. Mother DISCUSSION
gave us a history of child playing in the muddy soil. Cutaneous larva migrans is also known as “sand
On examination, eczematous curvilinear tract of about worms,” creeping verminous dermatitis, creeping
12 cms in length was seen on the dorsum of the right eruption, plumber’s itch and duck hunter’s itch.[2] In
foot [Figure 3]. Systemic examination revealed no Indian scenario, the disease commonly occurs in the
abnormality. Laboratory analysis was normal. Based coastal areas of the country where the suitable condition
on history and examination, a diagnosis of cutaneous exists.[3] Human gets infected while walking barefoot
larva migrans was entertained. on soil contaminated with faeces. The filariform
larvae of the parasite penetrate into the skin. The
Case 4
commonly affected areas are dorsum and sole of the
A 14‑year‑old male child presented with progressive
feet, buttocks, and legs. The larvae secretes proteases
single itchy lesion over left thigh over 1 week duration.
and hyaluronidase which facilitate the penetration and
Father gave a history of child playing throwball
migration through the epidermis.[4] The larvae wander
in the sand. He had no other symptoms and was
in serpiginous route in the epidermis of skin at a speed
otherwise well. On cutaneous examination, there was
of 3 cm/day. Clinically, the primary lesion is pruritic,
an erythematous curvilinear tract of about 15 cm
erythematous serpiginous burrow.[2] Larvae die usually
long on the lateral aspect of left thigh [Figure 4].
in 2–8 weeks. Survival up to 2 years has been reported.
The remainder of his physical examination was
The incubation period ranges from 1 to 6 days.
unremarkable. His peripheral blood analysis reports
were within normal limits. Based on history and

Figure 2: Erythematous, serpentine, pruritic cutaneous lesion over dorsum

right hand

Figure 1: Raised, erythematous, thread like tract on the buttocks of size

approximately 10 cm length, healing at one end and progressing at another
end

Figure 3: eczematous curvilinear tract of about 12 cms in length was seen Figure 4: Erythematous curvilinear tract of about 15 cm long on the
on the dorsum of the right foot lateral aspect of left thigh

Indian Journal of Paediatric Dermatology | Vol 18 | Issue 1 | Jan-Mar 2017 37

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Paul and Singh: Cutaneous larva migrans

Diagnosis is based on history and clinical examination. and avoiding contact with contaminated soils help
Peripheral eosinophilia and increased serum IgE may in prevention. Both health education and control
be seen.[4] Epiluminescence microscopy is an effective of animal reservoirs can be effective in controlling
noninvasive method to detect larva and confirm the cutaneous larva migrans.
diagnosis.[5]
Financial Support and Sponsorship
Complications of cutaneous larva migrans are Nil.
infective and allergic. Infective includes superadded
infections with staphylococcus pyogenes due to Conflicts of Interest
eczematization.[6] Rarely, it may present with There are no conflicts of interest.
folliculitis and allergic pulmonary response (present
as Loffler’s syndrome). It has to be differentiated from
scabies, erythema chronicum migrans, larva currens,
REFERENCES
phytophotodermatitis, and dermatophyte infection.[7] 1. Meffert JI. Parasitic infestations. In: Fitzpatrick TB, Aeling J,
editors. Dermatology Secrets. 1st ed. New Delhi, India: Jaypee
All patients were treated with oral albendazole and showed Brothers; 1977. p. 217.

complete clearance of the lesions during follow‑up.
However, a single dose of ivermectin (200 μg/kg) and
3 days regimen of albendazole (400 mg/day) has a
similar efficacy of 92–100%.[6] Rarely, thiabendazole
is used orally and topically as it is associated with
gastrointestinal disturbances. Freezing the leading
point of the burrow is an effective older method of
treatment.[2] Sometimes, it produces significant tissue
destruction. The larva is up to 2 cm. ahead of the visible
burrow, and hence may cause treatment failure.
The prognosis is excellent. Awareness, early recognition
and treatment help in preventing complication.
By treating cats and dogs with anthelmintic drugs
2. Padmavathy L, Rao LL. Cutaneous larva migrans – A case
report. Indian J Med Microbiol 2005;23:135‑6.
3. Karthikeyan K, Thappa DM. Cutaneous larva migrans. Indian
J Dermatol Venereol Leprol 2002;68:252‑8.
4. Siddalingappa K, Murthy SC, Herakal K, Kusuma MR.
Cutaneous larva migrans in early infancy. Indian J Dermatol
2015;60:522.
5. Elsner  E, Thewes  M, Worret  WI. Cutaneous larva migrans
detected by epiluminescent microscopy. Acta Derm Venereol
1997;77:487‑8.
6. Kaur S, Jindal N, Sahu P, Jairath V, Jain VK. Creeping eruption
on the move: A  case series from Northern India. Indian J
Dermatol 2015;60:422.
7. Dhanaraj  M, Ramalingam  M. Cutaneous larva migrans
masquerading as tinea corporis: A case report. J Clin Diagn Res
2013;7:2313.

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38 Indian Journal of Paediatric Dermatology | Vol 18 | Issue 1 | Jan-Mar 2017