One of the most common parasitic infestations affecting travellers returning from beach destinations in the Caribbean, Mexico, Brazil, and Southeast Asia.
Characterised by intensely pruritic serpiginous or linear raised erythematous tracks. Lesions occur on unprotected skin (most commonly involving the feet) that has come into contact with sandy, moist soil contaminated by dog or cat faeces containing hookworm eggs.
Diagnosis made on clinical grounds.
Although usually self-limiting, oral anthelmintic treatment speeds up resolution of symptoms and is considered curative.
Cutaneous larva migrans (CLM) is a self-limiting dermatosis caused by the migration of animal hookworm larvae (most commonly the dog hookworm Ancylostoma caninum and the cat hookworm Ancylostoma braziliense) in the skin. It is characterised by serpiginous or linear raised erythematous tracks that are usually intensely pruritic and occur on unprotected skin (most commonly involving the feet) that has come into contact with sandy, moist soil contaminated by dog or cat faeces containing hookworm eggs in areas of the tropics and subtropics.
History and exam
Key diagnostic factors
- recent travel to tropics or subtropics
- barefoot beachgoer/sunbather
- creeping, raised, erythematous track
- intense pruritus
Other diagnostic factors
- vesiculobullous or papular lesions
- recent travel to or residence in an endemic area
- walking barefoot and/or sunbathing on contaminated beach
1st investigations to order
- no test required: diagnosis is clinical
Investigations to consider
- skin scrapings/biopsy
- epiluminescence microscopy
non-pregnant adults and children
no response to initial treatment or relapse
David J. Diemert, MD, FRCP(C)
Departments of Medicine and Microbiology, Immunology and Tropical Medicine
The George Washington University School of Medicine and Health Sciences
DJD declares that he has no competing interests.
Eric Caumes, MD
Professor of Infectious and Tropical Diseases
Universite Pierre et Marie Curie
Department of Infectious and Tropical Diseases
EC is an author of a number of references cited in this topic.
Jorg Heukelbach, MD, PhD
Department of Community Health
School of Medicine
Federal University of Ceara
JH is an author of a number of references cited in this topic.
Brett Hendel-Paterson, MD, CTM
Internal Medicine and Pediatrics Hospitalist
Health Partners Regions Hospital
Attending Physician in Travel Clinic
Assistant Professor of Medicine
University of Minnesota
BHP declares that he has no competing interests.
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