Merck Manual

Please confirm that you are a health care professional

honeypot link

Cutaneous Larva Migrans

(Creeping Eruption)

By

James G. H. Dinulos

, MD, Geisel School of Medicine at Dartmouth

Reviewed/Revised Oct 2023
View PATIENT EDUCATION
Topic Resources

Cutaneous larva migrans is the skin manifestation of hookworm infestation. Diagnosis is clinical. Treatment is oral or topical antihelminthic therapy.

Cutaneous larva migrans is caused by Ancylostoma species, most commonly dog or cat hookworm Ancylostoma braziliense.

Hookworm ova in dog or cat feces develop into infective larvae when left in warm moist ground or sand. Transmission occurs when skin directly contacts contaminated soil or sand and larvae penetrate unprotected skin, usually of the feet, legs, buttocks, or back.

Cutaneous larva migrans occurs worldwide but most commonly in tropical environments. Emergence of this condition in previously naive countries is thought to be due to climate change (1 General references Cutaneous larva migrans is the skin manifestation of hookworm infestation. Diagnosis is clinical. Treatment is oral or topical antihelminthic therapy. Cutaneous larva migrans is caused by Ancylostoma... read more General references ).

Cutaneous Larva Migrans

Cutaneous larva migrans causes intense pruritus. Signs are erythema and papules at the site of entry, followed by a winding, threadlike subcutaneous trail of reddish brown inflammation. Patients may also develop papules and vesicles resembling folliculitis Folliculitis Folliculitis is an infection of hair follicles. Diagnosis is clinical. Treatment for most cases of bacterial folliculitis is with topical mupirocin or clindamycin. (See also Overview of Bacterial... read more Folliculitis , called hookworm folliculitis.

Diagnosis of cutaneous larva migrans is by history and clinical appearance.

General references

  • 1. Ahmed A, Hemaida MA, Hagelnur AA, et al: Sudden emergence and spread of cutaneous larva migrans in Sudan: A case series calls for urgent actions. IDCases 32:e01789, 2023. doi: 10.1016/j.idcr.2023.e01789

  • 2. Podder I, Chandra S, Gharami RC: Loeffler's syndrome following cutaneous larva migrans: An uncommon sequel. Indian J Dermatol 61(2):190–192, 2016. doi: 10.4103/0019-5154.177753

Treatment of Cutaneous Larva Migrans

  • Oral or topical antihelminthic therapy

Although the infection usually resolves spontaneously after a few weeks, discomfort and the risk of secondary bacterial infection warrant treatment.

Treatment consists of antihelminthic therapy with oral or topical agents. Oral medications are generally preferred because they are generally well-tolerated and easier to use and obtain than topical agents. Oral ivermectin and albendazole are effective treatment options. Topical albendazole 10% ointment (compounded) and thiabendazole 15% liquid or cream (compounded) can be used as alternatives.

Drugs Mentioned In This Article

Drug Name Select Trade
Sklice, Soolantra, Stromectol
Albenza
View PATIENT EDUCATION
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
quiz link

Test your knowledge

Take a Quiz! 
iOS ANDROID
iOS ANDROID
iOS ANDROID
TOP