Skin nontumor
Infestations
Cutaneous larva migrans

Author: Nemanja Rodic, M.D. (see Authors page)

Revised: 22 March 2017, last major update March 2017

Copyright: (c) 2017, PathologyOutlines.com, Inc.

PubMed search: cutaneous larva migrans [title]

Cite this page: Cutaneous larva migrans. PathologyOutlines.com website. http://pathologyoutlines.com/topic/skinnontumorlarvamigrans.html. Accessed August 16th, 2017.
Definition / general
  • Localized curvilinear and pruritic lesions collectively identified clinically as cutaneous larva migrans
  • Such infestations, most commonly due to hookworms, occur because humans are dead end hosts of penetrating nematode larvae
Etiology
  • Ova of helminths are deposited in sand and soil in warm and shady areas, where larvae hatch
  • Activities such as walking barefoot on the beach, playing in the sand and crawling under houses allow larvae to penetrate human skin
  • Hookworms such as Ancylostoma braziliense (dog and cat hookworms) and Ancylostoma caninum (dog hookworms) are most common causes of cutaneous larva migrans
  • Many other penetrating nematode larvae cause cutaneous larva migrans, such as:
    • Uncinaria stenocephala (hookworm of European dogs)
    • Bunostomum phlebotomum (hookworm of cattle)
    • Guinea worm (dracunculiasis)
    • Liver flukes (fascioliasis)
    • Genus Gnathostoma (gnathostomiasis)
    • Hookworms
    • African eye worm (loiasis)
    • Paragonimus westermani (paragonimiasis)
    • Spirometrosis (sparganosis)
    • Strongyloides stercoralis (strongyloidiasis)
  • Rarely fly larvae (maggots) can cause myiasis, which can also cause migratory dermatologic lesions
Epidemiology
  • Seen in U.S. travelers returning home after holidays
  • Endemic in subtropical areas, such as southeast U.S., Carribbean, Africa, Central America and Southeast Asia
Sites
  • Exposed distal portions of upper / lower limbs and buttocks are most commonly affected anatomic sites
Pathophysiology
  • Localized dermal inflammatory reaction including eosinophilic infiltrate and edema
  • Sometimes larvae move deeper into subcutaneous fat
Etiology
  • Helminth infestation
Clinical features
  • Most common finding is localized pruritis; however, some helminths can cause secondary systemic symptoms, as larvae enter blood vessels and migrate to intestinal mucosa (example, Strongyloidiasis)
  • Helminths may also cause visceral larva migrans, such as due to Toxocara canis, Toxocara cati, Ascaris lumbricoides, whereby larvae enter via tubular GI and secondarily cause disseminated visceral and cutaneous findings
Diagnosis
  • Clinicopathologic findings
Laboratory
  • Peripheral eosinophilia
  • Skin biopsy from advancing point of the lesion can show parts of parasite(s)
Treatment
  • Avoid direct skin contact with contaminated soil
  • Topical glucocorticoid application under occlusion for symptomatic relief
  • Antihelmintic agents such as thiabendazole, ivermectin, albendazole for topical or systemic treatment
Clinical images

Images hosted on other servers:

Various images

Gross description
  • Lesions show surrounding erythema and have serpiginous shape and tunnel-like contour
Microscopic (histologic) description
  • Curvilinear eosinophilic larvae within the epidermis
Microscopic (histologic) images

Images hosted on other servers:

Various images