Cutaneous Larva Migrans Infestation on Darker Skin

00:01 Welcome to our lecture on cutaneous larva migrans.

00:06 It's a parasitic skin infection caused by hookworm larva, typically infesting cats, dogs or other animals.

00:15 It's more common in warmer climates, especially in tropical and subtropical countries. It's also more prevalent among travelers, children, swimmers, and laborers whose activities bring their skin into contact with soil. It is caused by the hookworm Ancylostoma braziliense and ancylostoma caninum. The transmission is via animals and for example, dogs, cats are the definitive hosts.

00:56 The eggs are passed from animal feces into warm, moist soil. The larva hatch in the soil.

01:07 When humans touch contaminated soil.

01:10 Larva can partially penetrate the skin, and that's how it is transmitted to humans.

01:17 The clinical manifestations.

01:18 If we talk about the predilection sites, it's most common on the lower extremities and less common on the buttocks.

01:25 And anogenital region, as well as trunk and upper extremities, are less likely to be involved.

01:33 The clinical manifestations one sees edematous, erythematous and inflammatory serpiginous tracks again in skin of color, the erythema may look less prominent and it may be more grayish or dusky.

01:52 One can also present with vesicular vesiculobullous lesions, which are seen in some cases on the hands, as you can see on this picture.

02:02 This may lead to intense pruritis.

02:05 And if one compares the light skin and skin of color, the erythema is quite obvious on the right hand side.

02:12 In a patient with cutaneous larva migrans with very fair skin, and on the left side you can see that the erythema is less prominent because it is masked by melanin. We've spoken about clinical manifestations.

02:28 Now we're moving on to the complications of cutaneous larva migrans.

02:33 Pulmonary disease can be involved in the following ways.

02:39 Cellulitis and other bacterial skin infections are also common complication.

02:46 The diagnosis of cutaneous larva migrans is based on history of contact with contaminated soil. Physical examination shows the characteristic clinical manifestation, which is the serpiginous skin lesions.

03:03 Dermoscopy has been quite useful in assisting with diagnosis of this condition.

03:10 The differential diagnosis includes scabies, where one sees presence of burrows and erythematous plaques. Impetigo is another differential.

03:20 However, impetigo doesn't have the serpiginous lesions.

03:26 Allergic contact dermatitis is also a differential.

03:29 And again, you don't see the classical serpiginous lesions in allergic contact dermatitis. The management.

03:36 This condition is self-limiting.

03:39 Humans are accidental and dead end hosts.

03:44 However, under ant helmintic therapy, for example, albendazole, ivermectin, and thiabendazole can be used to treat cutaneous larva migrans.

03:57 And of course, cryotherapy is also an option for treating cutaneous larva migrans.