Cutaneous Larva Migrans in Children
Introduction to Cutaneous Larva Migrans in Children
Cutaneous Larva Migrans (CLM), also known as creeping eruption or sandworm disease, is a parasitic skin infection commonly seen in children. It is caused by the larvae of various nematode parasites, typically hookworms, that penetrate and migrate through the skin. CLM is prevalent in tropical and subtropical regions and is often associated with walking barefoot on contaminated soil or sand.
Etiology of Cutaneous Larva Migrans
CLM is primarily caused by the larvae of animal hookworms, most commonly:
- Ancylostoma braziliense (dog and cat hookworm)
- Ancylostoma caninum (dog hookworm)
- Uncinaria stenocephala (European dog hookworm)
Less common causative agents include:
- Strongyloides stercoralis
- Gnathostoma spinigerum
- Dirofilaria repens
Epidemiology of Cutaneous Larva Migrans in Children
CLM is endemic in tropical and subtropical regions, particularly in:
- Southeast Asia
- Africa
- South America
- Caribbean Islands
- Southern United States
Risk factors in children include:
- Walking barefoot on contaminated beaches or soil
- Playing in sandboxes contaminated with animal feces
- Poor sanitation and hygiene practices
- Travel to endemic areas
Incidence peaks during warm, humid seasons when larvae survival in the environment is optimal.
Pathophysiology of Cutaneous Larva Migrans
The pathophysiology of CLM involves the following steps:
- Larvae penetrate the skin, usually through hair follicles or small abrasions
- Lacking the enzymes to penetrate the basement membrane, larvae remain confined to the epidermis
- Larvae migrate through the epidermis at a rate of several millimeters to a few centimeters per day
- Host immune response is triggered, leading to intense pruritus and inflammation
- Larvae eventually die within the epidermis, as humans are not suitable definitive hosts
The immune response involves eosinophilia and elevated IgE levels, contributing to the characteristic symptoms and serpiginous lesions.
Clinical Presentation of Cutaneous Larva Migrans in Children
Key clinical features include:
- Erythematous, pruritic, serpiginous or linear tracks (2-3 mm wide)
- Lesions commonly found on feet, legs, buttocks, and hands
- Intense pruritus, often worse at night
- Vesicles or papules may develop along the tract
- Advancement of tract by 2-5 cm per day
- Secondary bacterial infections due to scratching
- Rarely, systemic symptoms like cough or abdominal pain (in heavy infestations)
In children, multiple lesions are common due to increased exposure and thinner stratum corneum.
Diagnosis of Cutaneous Larva Migrans
Diagnosis is primarily clinical, based on:
- Characteristic appearance of serpiginous, erythematous tracks
- History of exposure to contaminated soil or sand
- Intense pruritus
Supportive diagnostic tests include:
- Peripheral eosinophilia (in 20-35% of cases)
- Elevated serum IgE levels
- Skin biopsy (rarely performed, may show eosinophilic infiltration)
- Dermoscopy can visualize translucent, brownish areas corresponding to the larva
Differential diagnosis includes scabies, contact dermatitis, and other parasitic infections.
Treatment of Cutaneous Larva Migrans in Children
Treatment options include:
- Systemic antihelminthic therapy (preferred):
- Ivermectin: 200 μg/kg as a single dose, may repeat after 1-2 weeks if necessary
- Albendazole: 400 mg once daily for 3-7 days
- Topical treatments (for limited disease):
- Thiabendazole 10% cream applied 3 times daily for 5-10 days
- Albendazole 10% cream applied twice daily for 10 days
- Symptomatic relief:
- Antihistamines for pruritus
- Topical corticosteroids for inflammation
For secondary bacterial infections, appropriate antibiotics should be prescribed.
Prevention of Cutaneous Larva Migrans in Children
Preventive measures include:
- Wearing shoes or sandals on beaches and in areas with potentially contaminated soil
- Using protective mats or chairs when sitting on sand
- Regularly deworming pets to reduce environmental contamination
- Proper disposal of animal feces in public areas
- Educating children and parents about the risks and preventive measures
- Improving sanitation in endemic areas
Complications of Cutaneous Larva Migrans in Children
While CLM is generally self-limiting, potential complications include:
- Secondary bacterial infections due to scratching
- Cellulitis
- Impetigo
- Rarely, systemic manifestations:
- Löffler's syndrome (pulmonary eosinophilia)
- Eosinophilic enteritis
- Psychological distress due to persistent pruritus and visible lesions
Prognosis of Cutaneous Larva Migrans in Children
The prognosis for CLM is generally excellent:
- Self-limiting condition, resolving within 2-8 weeks without treatment
- With appropriate treatment, resolution occurs within 1-2 weeks
- No long-term sequelae in most cases
- Reinfection is possible with repeated exposure
- Rare cases of persistent infection may occur in immunocompromised children
Early diagnosis and treatment can significantly reduce morbidity and improve quality of life for affected children.
Cutaneous Larva Migrans in Children: Objective QnA
- What is the causative agent of cutaneous larva migrans?
Answer: Hookworm larvae, typically from animal species like Ancylostoma braziliense or Ancylostoma caninum - Which body parts are most commonly affected by cutaneous larva migrans in children?
Answer: Feet, buttocks, and hands - What is the characteristic appearance of cutaneous larva migrans lesions?
Answer: Erythematous, serpiginous, and pruritic tracks - How do children typically acquire cutaneous larva migrans?
Answer: By walking barefoot or playing on contaminated soil or sand - What is the incubation period for cutaneous larva migrans?
Answer: Usually a few days to several weeks - Can cutaneous larva migrans be transmitted from person to person?
Answer: No, it is not directly transmissible between humans - What is the most common symptom of cutaneous larva migrans in children?
Answer: Intense itching (pruritus) - How fast do the skin lesions of cutaneous larva migrans typically progress?
Answer: 1-2 cm per day - What complications can arise from scratching cutaneous larva migrans lesions?
Answer: Secondary bacterial infections - Which diagnostic method is typically used for cutaneous larva migrans?
Answer: Clinical diagnosis based on characteristic appearance and history - Are skin biopsies routinely performed for diagnosing cutaneous larva migrans?
Answer: No, they are rarely necessary or helpful - What is the first-line treatment for cutaneous larva migrans in children?
Answer: Oral albendazole or ivermectin - How long does it typically take for cutaneous larva migrans to resolve without treatment?
Answer: Several weeks to months - Can topical thiabendazole be used to treat cutaneous larva migrans?
Answer: Yes, it can be effective for localized lesions - What preventive measure is most effective against cutaneous larva migrans in children?
Answer: Wearing shoes when walking on potentially contaminated soil or sand - Can cutaneous larva migrans cause systemic symptoms in children?
Answer: Rarely, it may cause mild eosinophilia or low-grade fever - What is "creeping eruption" in relation to cutaneous larva migrans?
Answer: It's another name for cutaneous larva migrans, describing the moving skin lesion - How deep do the larvae typically penetrate in cutaneous larva migrans?
Answer: They remain in the epidermis, unable to penetrate deeper layers - Can cutaneous larva migrans resolve on its own without treatment?
Answer: Yes, but it may take several weeks to months - What is the role of corticosteroids in managing cutaneous larva migrans?
Answer: They may provide temporary symptomatic relief but do not treat the underlying condition - Are there any long-term consequences of untreated cutaneous larva migrans in children?
Answer: Generally no, but prolonged discomfort and potential secondary infections can occur - Can cutaneous larva migrans recur after successful treatment?
Answer: Yes, if re-exposed to contaminated environments - What is the typical dosage of albendazole for treating cutaneous larva migrans in children?
Answer: 400 mg once daily for 3-7 days - How soon after treatment initiation do symptoms of cutaneous larva migrans usually improve?
Answer: Within 24-48 hours - Can cutaneous larva migrans affect mucous membranes?
Answer: Rarely, it can affect the oral mucosa if eggs are ingested - What is the role of antihistamines in managing cutaneous larva migrans?
Answer: They can help relieve itching but do not treat the underlying condition - Are there any specific dietary restrictions for children with cutaneous larva migrans?
Answer: No, there are no specific dietary restrictions associated with this condition - Can cutaneous larva migrans be prevented by regular deworming of pets?
Answer: Yes, regular deworming of dogs and cats can help reduce environmental contamination - What is the risk of cutaneous larva migrans in children who frequently visit beaches?
Answer: Higher risk, especially if walking barefoot on contaminated sand - Can cutaneous larva migrans cause anemia in affected children?
Answer: No, unlike intestinal hookworm infections, cutaneous larva migrans does not cause anemia
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