Serpentine Skin Lesion on Foot with Intense Itching

Cutaneous larva migrans (CLM). It is a self-limited dermatosis caused by the infection and migration of an animal hookworm larvae in patient’s epidermis. The most common parasites that cause CLM are Ancylostoma caninum and Ancylostoma braziliense, who have dogs and cats as their hosts.¹ CLM is characterized by serpiginous or linear raised erythematous tracks, intensely pruritic that occur on unprotected skin (typically involving the feet) that has come into contact with sandy, moist soil contaminated by dog or cat feces containing hookworm eggs, with conditions for infection being more favorable in tropical or subtropical climates.² In most cases, the diagnosis of CLM is based on the typical skin findings and the previous travel history with a real possibility of exposure as was seen in our patient.³ Complications include impetigo and local or general allergic reactions. Although the disease might be self-limited, spontaneous cure takes several weeks or months. The potential complications, together with the intense pruritus and the duration of the disease, justifies the treatment. Treatment options include oral albendazole (for children with more than 2 years old: 400 mg once a day for 3 to 7 days) or oral ivermectin (for children more than 15 kg: 200 mcg/kg as a single dose).⁴
Because tourists are usually infected by walking or lying on tropical sandy beaches contaminated by dog feces, the best way to prevent CLM is to ban dogs from beaches or wear suitable footwear when walking in sandy areas.²

References :

Le Joncour A, Lacour SA, Lecso G, Regnier S, Guillot J, Caumes E. Molecular characterization of Ancylostoma braziliense larvae in a patient with hookworm-related cutaneous larva migrans. Am J Trop Med Hyg. 2012;86:843 Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm related cutaneous larva migrans. Lancet Infect Dis. 2008;8:302-309. Leung AKC, Barankin B, Hon KLE. Cutaneous Larva Migrans. Recent Pat Inflamm Allergy Drug Discov. 2017;11:2-11 American Academy of Pediatrics. [Chapter title.] In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015:315-316;932