Cutaneous Larva Migrans in a Girl

Hervina

Departement of Dermatology and Venereology, RSUD Dr. R.M Djoelham Binjai Hospital – Medan, Indonesia

Keyword : Cutaneus Larva Migrans, a girl, 18-year-old

Abstract: Cutaneous larvae migrants (CLM) is a skin disease which is a linear or winding and progressive winding

inflammation caused by invasion of hookworm larvae originating from dogs and cats.

Cutaneous larvae

migrants (CLM) are skin disorders caused by larvae hookworm. The main causes are hookworm larvae

originating from dogs and cats, namely Ancylostoma braziliense and Ancylostoma caninum. In East Asia,

CLM is generally caused by gnatostomas in pig and cat animals

An 18-year-old girl came to the skin clinic and sex center at the DR. R.M Djoelham Binjai with complaints

of red pimples forming an elongated line that meanders in the skin accompanied by itching, this has been

experienced since ± 1 month ago.

This skin disorder is also known as creeping eruption, creeping verminous dermatitis, stray larvae, migraine

dermatosis, sandworm disease, plumber 's itch, duck hunter' s itch.

CLM has a wide distribution, mostly in

warm and humid tropical and subtropical climates.

One case of CLM has been reported based on clinical findings in the form of very itchy lesions on the

surface of the abdomen and upper thighs with tunnel-shaped images of serpiginous papules similar to the

skin. Patients were given single dose of albendazole 400 mg for 3 days and oral antihistamines. On the fifth

day after therapy, the lesion undergoes spontaneous resolution and symptoms disappear.

1 INTRODUCTION

Cutaneous larvae migrants (CLM) is a skin disease

which is a linear or winding and progressive

winding inflammation caused by invasion of

hookworm larvae originating from dogs and cats.

Cutaneous larvae migrants (CLM) are skin disorders

caused by larvae hookworm. The main causes are

hookworm larvae originating from dogs and cats,

namely Ancylostomabraziliense and

Ancylostomacaninum. In East Asia, CLM is

generally caused by gnatostomas in pig and cat

animals. In some cases Uncinariastenocephala

(hookworm from European dogs) and

Bunostomumphlebotomum (hookworm from a type

of cattle) can be found (Baple et al, 2015). Creeping

Eruption is a typical skin disorder in the form of a

straight or winding line, progressive, due to stray

larvae (Siregar, 2013). This CLM has been known

since 1874 then in 1929 it was known that this

disease was associated with subcutaneous migration

of Ancylostoma larvae (Eckert, 2005).

Hygiene or hygiene factors play an important

role in the spread of disease (Eckert, 2005). These

skin disorders are transmitted through direct contact

with sand or soil contaminated with animal waste

containing arvafilariform (infective larvae). Larvae

can penetrate the surface of the skin, migrate along

the epidermis and leave a linear or serpiginous

characteristic rash commonly known as 'creeping

eruption'. Most larvae cannot develop into an adult

form or invade the deeper layers of the skin. The

larva can die on its own in a few weeks to several

months (Aisah, 2010; Supplee et al, 2013).

2 CASE REPORT

An 18-year-old girl came to the skin clinic and sex

center at the DR. R.M Djoelham Binjai with

complaints of red pimples forming an elongated line

that meanders in the skin accompanied by itching,

this has been experienced since ± 1 month ago.

From the results of the history of the patient, it was

found that the initial complaint arose ± 1 month ago

with the initial condition felt itchy, then the rash

started with a small wound, the longer it expanded to

form a winding and very itchy tunnel especially at

Hervina, .

Cutaneous Larva Migrans in a Girl.

DOI: 10.5220/0009990003990401

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 399-401

ISBN: 978-989-758-469-5

399

night. then a winding line appears in the thigh

section,

The patient has experienced this disorder for the

first time, there is no history of drug use, and a

history of food allergies.

Physical examination found the patient looked

good with good nutrition. Its generalization status is

within normal limits. Dermatological status in the

abdominal region, inferior limb region.In this patient

Albendazole 2 x 400 mg was given for 3 days,

Cetirizine 10 mg (if itchy), Ethyl Chloride (spray)

was given 1 x 1. 2 weeks later the rash in the patient

experienced healing.

Figure: Creeping Eruption

3 DISCUSSION

Cutaneous larvae migrants (CLM) are typical skin

disorders in the form of linear or winding,

embossed, and progressive inflammation, caused by

invasion of hookworm larvae originating from dogs

and cats, namely Ancylostomabraziliense and

Ancylostomacaninum. This skin disorder is also

known as creeping eruption, creeping verminous

dermatitis, stray larvae, migraine dermatosis,

sandworm disease, plumber 's itch, duck hunter' s

itch. (Siregar, 2013) CLM has a wide distribution,

mostly in warm and humid tropical and subtropical

climates. Hygiene and sanitation factors play an

important role. (Siregar, 2013;Padmavaty et al,2015)

Humans are incidental hosts, infections occur due to

direct contact between the skin and sand or soil

contaminated with animal waste containing

filariform larvae (infective larvae) hookworms.

(Baple et al, 2015; Supplee et al, 2013).

Larval entry into the skin is usually accompanied

by itching and heat. Itching is usually more severe at

night. At first papules will appear, then followed by

a distinctive form, namely linear or winding lesions,

arising with a diameter of 3 mm, reddish.

Erythematous papule lesions suggest that larvae

have been on the skin for several hours or days.

Furthermore, this red papule spreads like a winding

thread, polycyclic, serpiginose, arises, and forms a

tunnel (burrow), reaching a length of several

millimeters to centimeters per day. Predilections on

the back of the hands, limbs, plantar, soles of the

feet, anus, buttocks and thighs, can also be found in

parts of the body that are often in direct contact with

sand or soil where larvae are located (Eckert, 2005).

A study in Brazil reported that the lesion length was

significantly related to duration or the duration of

infection, the average length of 2.7 mm per day, so it

can help estimate the time and place of exposure to

infection.

Another clinical manifestation is hookworm

folliculitis. Patients usually present with pruritic

folliculitis and creeping eruption. Folliculitis can be

in the form of 20-100 follicular papules and pustules

spread in certain areas, usually in the buttocks. It can

also be found 2-10 lesions in the form of linear

(burrow) or serpiginose tunnels of 1-5 centimeters in

the same or different locations. (Baple et al, 2015)

these patients the therapy given is in accordance

with the theory that first-line therapy is albendazole

(400-800 mg / day) single dose orally for three days

or anti-helminticivermectin (150-200 µg / kg body

weight) single dose. (Eckert, 2005) The cure rate

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

400

reaches 100 percent. However, because other safe

and sufficiently effective options are topical

tiabendazole and topical albendazole this drug is not

available in all countries, then other therapies with

ethyl chloride are given even though it is not

recommended. (Aisah, 2010)

4 CONCLUSION

Cutaneous larval migrans (CLM) is a skin disorder

caused by animal hookworm larvae originating from

dogs and cats, namely Ancylostomabraziliense and

Ancylostomacaninum. One case of CLM has been

reported based on clinical findings in the form of

very itchy lesions on the surface of the abdomen and

upper thighs with tunnel-shaped images of

serpiginous papules similar to the skin. Patients were

given single dose of albendazole 400 mg for 3 days

and oral antihistamines. On the fifth day after

therapy, the lesion undergoes spontaneous resolution

and symptoms disappear.

REFERENCES

Aisah S.. 2010.Ilmu penyakit kulit dan kelamin. Edisi ke-

6. Jakarta: Balai Penerbit FKUI

Baple K, Clayton J. 2015. Hookworm-related cutaneous

larva migrans acquired in the UK: Case report. BMJ

Case Rep.

Eckert J. 2005. Larva migrainsexterna or cutaneous larva

migrains, dalam :BienzKA,editor. Medical

microbiology. New york: Thiame Medical Publisher.

Falabela R, Barona MI. 2008. Update on skin

repigmentationtherapies in vitiligo. Pigment Cell

Melanoma Res. 22: 42–65.

Padmavathy L, Rao LL. 2015. Cutaneous larva migrans: A

case report. Indian J Med Microbiol. 23(2):135-6.

Radtke MA, Schafer I, Gajur A, Langenburch A, Augustin

A. 2009. Willingness to pay and quality of lifein

patients with vitiligo. Br J Dermatol. 161:134–9.

Siregar,R,S. 2013. Saripati Penyakit Kulit. Edisi 3.

Jakarta: Penerbit Buku Kedokteran EGC.

Supplee SJ, Gupta S, Alweis R. Creeping eruptions:

Cutaneous larva migrans. J Comm Hospital Intern

Med Perspectives. 2013;3:21833

Cutaneous Larva Migrans in a Girl

401