Creeping Eruption, Larva Migrans, and Larva Currens
Saturday, January 01, 2011
Cutaneous Larva Migrans (CLM)
The treatment for larva currens is somewhat different so
the two diseases are discussed separately.
Cutaneous larva migrans is due to animal (usually canine)
hookworm. It presents as serpiginous papules on the dorsal feet
and, less commonly, the other body sites contacting the sand when
sunbathing on the beach. Larva migrans is usually self-limited;
however, untreated cases, especially if extensive, may last for
months to years. The therapeutic strategy is to eliminate the
Oral ivermectin 12 mg as a single dose.
- Albendazole 400-800 mg daily for 3-7 days, depending on the
severity of the disease (3 days for single lesions, 5-7 days for
multifocal disease). (Albendazole is preferred over thiabendazole
because of the significantly lower rates of gastrointestinal [GI]
- Thiabendazole 15% ointment or cream applied 3 times daily for
5-10 days. Addition of dimethyl sulfoxide (DMSO) to the vehicle may
- About 90% of patients will be cured with the above regimens.
Patients failing to improve after a single dose of ivermectin
should have a second or third dose of 0.2 mg/kg as required every 2
- Patients failing to improve with topical thiabendazole or oral
albendazole should be treated with ivermectin. Patients failing to
improve after 3 doses of ivermectin should be treated with oral
- Despite the high success rates from the above regimens, at
least 5% of patients, especially those with more widespread
disease, may require more prolonged or repeated courses of
treatment. Relapses may occur up to 30 days following
- Failure of standard therapies to cure CLM may indicate
Larva currens, caused by intestinal infection with
Strongyloide stercoralis, presents with serpiginous
erythematous papules on the buttocks, upper thighs, and lower
abdomen. In the immunosuppressed host, larva currens may appear
anywhere on the body and suggests hyperinfection with hematogenous
Ivermectin 0.2 mg/kg daily for 1-2 days.
Patients failing to improve on short courses of ivermectin
should have longer courses or repeat courses at 10- to 14-day
- Albendazole has a low cure rate in strongyloidiasis, and should
not be used as first-line therapy.
- Thiabendazole 50 mg/kg twice daily (maximum 3g/day) for 2
consecutive days is effective, but GI intolerance and hepatitis may