Cutaneous larva migrans is a skin disease in humans, caused by the larvae of various nematode parasites of the hookworm family. These parasites live in the intestines of dogs, cats, and wild animals and should not be confused with other members of the hookwormfamily for which humans are definitive hosts, namely Ancylostoma duodenale and Necator americanus. Colloquially called creeping eruption due to its presentation, the disease is also somewhat ambiguously known as "ground itch" or "sandworms", as the larvae like to live in sandy soil. Another vernacular name is plumber's itch. The medical term CLM literally means "wandering larvae in the skin".
Symptoms and signs
The infection causes a red, intensely pruritic eruption, and may look like twirling lesions. The itching can become very painful and if scratched may allow a secondary bacterial infection to develop. Cutaneous larva migrans usually heals spontaneously over weeks to months and has been known to last as long as one year. However, the severity of the symptoms usually causes those infected to seek medical treatment before spontaneous resolution occurs. Following proper treatment, migration of the larvae within the skin is halted and relief of the associated itching can occur in less than 48 hours. This is separate from the similar cutaneous larva currens which is caused by Strongyloides. Larva currens is also a cause of migratory pruritic eruptions but is marked by 1) migratory speed on the order of inches per hour 2) perianal involvement due to autoinfection from stool and 3) a wide band of urticaria.
Cause
Hookworm eggs are shed in the infected dog feces to the ground and beach sand, where they then develop over a period of 1–2 weeks into the infectious larval form. The filariform larvae can burrow through intact skin that comes into contact with soil or sand that is contaminated with feces. Although they are able to infect the deeper tissues of animals, humans are incidental hosts and the larvae are only able to penetrate the epidermis of the skin and thus create the typical wormlike burrows visible underneath the skin. These parasites apparently lack the collagenase enzymes required to penetrate through the basement membrane deeper into the dermal layers of the skin.
Topical freezing agents, such as ethylene chloride or liquid nitrogen, applied locally can freeze and kill the larvae, but this method has a high failure rate because the larvae are usually located away from the site of the visible skin trails. Additionally, this is a painful method which can cause blistering and/or ulceration of the skin and it is therefore not recommended.
It is recommended to use Benadryl or some anti-itch cream. This will help relieve some of the itch.
Wearing shoes in areas where these parasites are known to be endemic offers protection from infection. In general, avoiding exposure of skin to contaminated soil or sand offers the best protection. In some areas dogs have been prohibited from beaches in an attempt to control human infection.
