Larval stages of dog and cat hookworms (usually Ancylostoma spp.).
Skin contact with contaminated soil or sand.
Most cases are reported in travelers to the Caribbean, Africa, Asia, and South America. Beaches (and sandboxes) where domestic animals may roam are a common source of infection. Infection occurs in short-term as well as long-term travelers.
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.
Cutaneous larva migrans is self-limiting; migrating larvae usually die after 5–6 weeks. Albendazole is very effective for treatment. Ivermectin is effective but not approved for this indication. Symptomatic treatment for frequent severe itching may be helpful.
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.
Vanhaecke C, Perignon A, Monsel G, Regnier S, Bricaire F, Caumes E. The efficacy of single dose ivermectin in the treatment of hookworm related cutaneous larva migrans varies depending on the clinical presentation. J Eur Acad Dermatol Venereol. 2014 May;28(5):655–7.