Flower lesion at my ankle

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  1. cutaneous_larva_migransPlease Describe the lesion?
  2. What are your diagnosis?
  3. Ho do you manage?

Cutaneous larva migrans (“CLM”) is a skin disease in humans, caused by the larvae of various nematode parasites, the most common of which in the Americas is Ancylostoma braziliense.

Sometimes referred to as “creeping eruption” or “ground itch”, in some parts of the Southern USA this condition is also referred to as “sandworms,” as the larvae like to live in sandy soil.


These parasites are found in dog and cat feces/urine and although they are able to infect the deeper tissues of these animals (through to the lungs and then the intestinal tract), in humans they are only able to penetrate the outer layers of the skin and thus create the typical wormlike burrows visible underneath the skin. The parasites apparently lack the collagenase enzymes required to penetrate through the basement membrane deeper into the skin.

Presentation

The infection causes a red, intense itching eruption. The itching can become very painful and if scratched may allow a secondary bacterial infection to develop. The itching will not stop, even after the parasites are dead.

Treatment

CLM can be treated in a number of different ways:

  • Systemic (oral) agents include albendazole (trade name Albenza) and ivermectin (trade name Stromectol).
  • Another agent which can be applied either topically or taken by mouth is thiabendazole (trade name Mintezol), an anti-helminthic. When taken orally, this medication is known to cause nausea. A topical preparation can be made by mixing the ground pills in vaseline. This mixture cn be spread lightly on the lesion and held in place with a band aid.

This produces local tissue levels sufficient to kill the parasite without the systemic side effects when taken orally.

  • Topical freezing agents, such as ethyl chloride or liquid nitrogen, applied locally can freeze and kill the larvae (but is often a hit-or-miss proposition).
  • It is reccomended to use Benadryl or some anti-itch cream (i.e. Cortizone or Calamine lotion). This will help relieve some of the itch.

See also

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