Creeping Eruption

Key Points
Parasitic skin disease
Caused by nematode parasites
Parasite is found in dog and cat feces

Cutaneous larva migrans is a parasitic skin disease cased by the larvae of various nematode parasites (hookworm), which can be found in the feces of dogs and cats. The parasites are only capable of penetrating the outer layer of skin, and can only create typical wormlike burrows visible underneath the skin. Humans can pick up the parasites by walking barefoot on beaches or soil. It’s found primarily in the Southeastern and Gulf states of the United States. They infect about 700 million people around the world, most frequently in children. The infection is red and can often cause intense itching. The itching continues even after the parasites are dead. Scratching, furthermore, can cause further infection.

Differential Diagnosis (Other conditions with similar appearance)

Scabies
Uticaria
Photodermatitis
Erythema chronicum migrans

Diagnosis
Key Points
microscopic inspection of feces or inspection of the skin

Visual inspection of the skin reveals itchy red lines and blisters. A skin biopsy may reveal larvae.

Treatment
Prevention is key
Treatment is primarily to prevent infection

Thiabendazole (trade name Mintezol), an anti-helminthic, is the most popular treatment, which can be taken orally or applied to the skin (side effects include dizziness, nausea, and vomiting). Benadryl or another anti-itch cream like Cortizone or Calamine lotion or relieve the itching. Topical freezing agents, in some cases, can be used to kill the larvae. The disease is self-limited, and recovery is complete. CLM usually last from between one and six months without treatment.