Barefoot answers

What is the infection?

Cutaneous larva migrans (CLM).

This is caused by infection with animal hookworm larva (typically a dog or cat species,  eg Ancylocystoma braziliense).

Infection is acquired via direct inoculation when a human comes into skin contact with faeces containing the larva (often on a beach or a riverbank). The larva cannot complete its usual life cycle in a human, hence it wanders around the epidermis causing an intense pruritic reaction. CLM, sometimes known as creeping eruption or “ground itch”, is common in tropical regions including northern Australia. It most commonly affects the feet, but can occur on any part of the body.

Secondary bacterial infection is not uncommon

What is the treatment?

CLM will eventually resolve without treatment when the larva(e) dies, but this can take many weeks. Systemic therapy options include albendazole, ivermectin or thiabendazole.

Topical therapies include:

  • Cryotherapy (eg ethyl chloride, liquid nitrogen) or other trauma to the leading edge of the lesion (to kill the migrating larva)
  • Thiabendazole cream applied to the lesions (not available on prescription in Australia; may be available via compounding pharmacies).

MMWR Morb Mort Wkly Rep. Outbreak of Cutaneous Larva Migrans at a Children’s Camp — Miami, Florida, 2006 (December 14, 2007 / 56(49);1285-1287.

The Stafinator, 7th April.

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