Cutaneous Larva Migrans

Cutaneous larva migrans is a skin condition caused by the larvae of certain animal hookworms, most often from dogs or cats, which penetrate human skin and migrate just beneath its surface, creating an intensely itchy, winding rash.

• An intensely itchy, red, raised, winding (serpiginous) track on the skin, which slowly advances over days as the larva migrates
• Most commonly affects the feet, particularly the soles, but can occur wherever bare skin has contacted contaminated soil or sand
• The track typically advances a few millimetres to a centimetre per day
• Scratching can lead to secondary bacterial skin infection

• Caused by larvae of hookworm species that normally infect dogs and cats, which are passed in the animal's faeces onto soil or sand.
• Humans become infected when bare skin, most often the feet, comes into contact with contaminated soil or sand, allowing the larvae to penetrate the skin.
• Since humans are not the natural host, the larvae cannot complete their life cycle in human skin and eventually die, but cause an itchy rash while migrating.

• Diagnosed clinically based on the highly characteristic appearance of an itchy, winding, slowly advancing skin track, together with a history of walking barefoot on sand or soil, particularly on a beach with animal traffic.

An oral antiparasitic medicine, such as albendazole or ivermectin, is highly effective and is the treatment of choice, given as a short course.

A topical antiparasitic cream may be used as an alternative for limited, localised lesions where available.

Antihistamines or a mild topical corticosteroid can help relieve itching while the infestation resolves.

Any secondary bacterial infection from scratching is treated with an appropriate antibiotic.

Without treatment, the condition eventually resolves on its own over weeks to a couple of months as the larva dies, but treatment significantly shortens the duration of itching and discomfort.

• Wear footwear on beaches, sandy areas, and soil where dogs or cats may have defecated.
• Avoid sitting or lying directly on sand in areas with significant animal traffic; use a mat or towel as a barrier.
• Support deworming of pet dogs and cats to reduce environmental contamination.
• Avoid barefoot walking in areas with poor animal waste management.