Larval stages of dog and cat hookworms (Ancylostoma spp.).
Skin contact with contaminated soil or sand.
Most cases are reported in travelers to the Caribbean, Africa, Asia, and South America. Beaches are a common source of infection.
Creeping eruption usually appears 1–5 days after skin penetration, but the incubation period may be ≥1 month. Typically, a serpiginous, erythematous track appears in the skin and is associated with intense itchiness and mild swelling. Usual locations are the foot and buttocks, although any skin surface coming in contact with contaminated soil can be affected.
Diagnosed on the basis of characteristic skin lesions. Biopsy is not recommended.
Albendazole is the treatment of choice. Ivermectin is effective but not approved for this indication.
Reduce contact with contaminated soil by wearing shoes and protective clothing and using barriers such as towels when seated on the ground.
Lederman ER, Weld LH, Elyazar IR, von Sonnenburg F, Loutan L, Schwartz E, et al. Dermatologic conditions of the ill returned traveler: an analysis from the GeoSentinel Surveillance Network. Int J Infect Dis. 2008 Nov;12(6):593–602.