Creeping eruption: causes, symptoms, diagnosis, and treatment

Creeping eruption, also known as cutaneous larva migrans, is an eruption caused by migration of hookworm larvae.


Causes

The disease is mainly caused by hookworm larvae that parasitize animals such as pigs, cats, cattle, goats, and sheep, mostly Ancylostoma braziliense, followed by Ancylostoma caninum, Bunostomum phlebotomum, Bunostomum trigoncephalum, Uncinaria stenocephala, and Gnathostoma spinigerum, as well as Strongyloides stercoralis parasitizing animals such as sheep, goats, cattle, pigs, and raccoons.


Signs and Symptoms

Symptoms occur several hours after the infective third-stage larva invades the skin. The larva migrates in the skin, and there are subjective pruritus and small, indurated bumps. With the migration of the larva under the skin, there are light red, creeping, slightly raised, linear or funicular skin lesions. Generally, the larva migrates about few centimeters a day, and the skin lesions advance and can be as long as 15 - 20cm. The old lesions subside. The larva may temporarily not migrate for several days or even months. Sometimes, the larva migrates after scratches. There may be secondary infection and suppuration, subjective intermittent sharp pain or pruritus, mostly on the exposed areas, but also on the buttocks and external genitalia.

Figure 1 creeping eruption

There may be complications such as Löffler syndrome, manifested by temporary, migratory pulmonary infiltrations, and eosinophils in the blood up to 51%.


Diagnosis

On the basis of typical skin lesions, the disease can be diagnosed.


Treatment

The treatment regimen is 15% thiabendazole solution or compound cream topically 2 - 3 times a day for 5 days, albendazole 400mg orally once a day for 3 - 7 days, or ivermectin 200mcg/kg orally once a day for 1 - 2 days.