Correspondence

Treatment of Cutaneous Larva Migrans

N Engl J Med 1998; 339:1246-1247October 22, 1998

Article

To the Editor:

Blaum and Omura (June 11 issue)1 report that they treated a case of cutaneous larva migrans with topical liquid-nitrogen cryotherapy. Apart from cryotherapy, various other therapeutic approaches have been used for this condition, including topical administration of thiabendazole and systemic administration of albendazole, thiabendazole, and ivermectin.2-5 Since freezing is often ineffective and not devoid of side effects,3,4 we conducted a prospective study of ivermectin, administered as a single oral dose of 12 mg, to travelers who had returned from various tropical or subtropical destinations.

From 1993 to 1997, we treated 67 consecutive outpatients who had one or more cutaneous larva migrans lesions. Data from 51 patients (28 men and 23 women; age range, 1 to 69 years; median age, 30 years) were available for evaluation. The lesions in 48 patients (94 percent) healed within five days (Figure 1Figure 1Healing Time for 50 Patients with Cutaneous Larva Migrans Treated with a Single Dose of 12 mg of Ivermectin.). Two patients were cured after 7 and 10 days. There were no side effects. Two of the patients in whom the lesions healed had relapses, but were cured within two days after a second round of treatment with the same dose of ivermectin. One other patient had an initial improvement but subsequently had repeated relapses, notwithstanding additional treatments (high-dose ivermectin and prolonged administration of albendazole). Her concurrent use of corticosteroids and azathioprine for Crohn's disease might have had a role in the repeated relapses. Ivermectin has a good safety profile,5 and we conclude that it should be seriously considered as an alternative to cryotherapy for the treatment of cutaneous larva migrans.

Erwin Van den Enden, M.D.
Ann Stevens, M.D.
Alphons Van Gompel, M.D.
Institute of Tropical Medicine, 2000 Antwerp, Belgium

5 References

1. 1

   Blaum JM, Omura EF. Cutaneous larva migrans. N Engl J Med 1998;338:1733-1733
   Full Text | Web of Science | Medline

2. 2

   Caumes E, Carriere J, Guermonprez G, Bricaire F, Danis M, Gentilini M. Dermatoses associated with travel to tropical countries: a prospective study of the diagnosis and management of 269 patients presenting to a tropical disease unit. Clin Infect Dis 1995;20:542-548
   CrossRef | Web of Science | Medline

3. 3

   Wolf P, Ochsendorf FR, Milbradt R. Aktuelle Therapiemöglichkeiten bei Larva migrans cutanea. Hautarzt 1993;44:462-465
   Web of Science | Medline

4. 4

   Davies HD, Sakuls P, Keystone JS. Creeping eruption: a review of clinical presentation and management of 60 cases presenting to a tropical disease unit. Arch Dermatol 1993;129:588-591
   CrossRef | Web of Science | Medline

5. 5

   Alexander NDE, Bockarie MJ, Kastens WA, Kazura JW, Alpers MP. Absence of ivermectin-associated excess deaths. Trans R Soc Trop Med Hyg 1998;92:342-342
   CrossRef | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: Both albendazole and thiabendazole have long been available for the treatment of cutaneous larva migrans (although albendazole has not been approved by the Food and Drug Administration [FDA] for this indication). Both drugs must be administered in multiple doses or applications. Cryotherapy for the single lesion in our patient was both effective and expedient. Because of the potential for cryotherapy to leave a small focus of altered pigmentation, particularly in persons with darker skin, it may not be a cosmetically acceptable approach in a patient with dozens of larvae. Our patient was seen and his photograph submitted to the Journal in 1993, three years before the FDA approved ivermectin for clinical use in the United States. Ivermectin was therefore not a therapeutic option for him.

Although ivermectin is currently approved by the FDA for the treatment of strongyloidiasis and onchocerciasis, it may be beneficial in the treatment of other parasitic infections, including cutaneous larva migrans, scabies, and infestation with lice.1 The information provided by Van den Enden et al., suggesting an expanded indication for the drug, is welcome.

Jane McClure Blaum, M.D.
Emily F. Omura, M.D.
University of Alabama School of Medicine, Birmingham, AL 35294

1 References

1. 1

   Drugs for parasitic infectionsMed Lett Drugs Ther 1998;40:1-12
   Web of Science | Medline

Citing Articles (14)

Citing Articles

1. 1

   H. Feldmeier, A. Schuster. (2011) Mini review: hookworm-related cutaneous larva migrans. European Journal of Clinical Microbiology & Infectious Diseases
   CrossRef

2. 2

   Antonia K. Kienast. 2011. Cutaneous Larva Migrans. , 68.1-68.5.
   CrossRef

3. 3

   Martina Prelog, Jörn Schönlaub, Lothar Bernd Zimmerhackl. (2011) Aciclovir and Varicella-zoster-immunoglobulin in solid-organ transplant recipients. Pediatric Nephrology 26:5, 663-673
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4. 4

   Jong-Yil Chai. (2011) Recent Advances in the Use of Anthelmintics for Treating Nematode Infections. Infection and Chemotherapy 43:1, 26
   CrossRef

5. 5

   Patrick Hochedez, Eric Caumes. (2007) Hookworm-Related Cutaneous Larva Migrans. Journal of Travel Medicine 14:5, 326-333
   CrossRef

6. 6

   Denis Malvy, Khaled Ezzedine, Thierry Pistone, Marie-Catherine Receveur, Maite Longy-Boursier. (2006) Extensive Cutaneous Larva Migrans With Folliculitis Mimicking Multimetameric Herpes Zoster Presentation in an Adult Traveler Returning From Thailand. Journal of Travel Medicine 13:4, 244-247
   CrossRef

7. 7

   2006. Other helminths. , 71-80.
   CrossRef

8. 8

   Mary E. Wilson, Lin H. Chen. (2004) Dermatologic infectious diseases in international travelers. Current Infectious Disease Reports 6:1, 54-62
   CrossRef

9. 9

   Terri L Meinking, Craig N Burkhart, Craig G Burkhart. (2003) Changing paradigms in parasitic infections: common dermatological helminthic infections and cutaneous myiasis. Clinics in Dermatology 21:5, 407-416
   CrossRef

10. 10

    Eric Caumes. (2003) Treatment of cutaneous larva migrans and Toxocara infection. Fundamental and Clinical Pharmacology 17:2, 213-216
    CrossRef

11. 11

    M. A. B. Roest, R. Ratnavel. (2001) Cutaneous larva migrans contracted in England: a reminder. Clinical and Experimental Dermatology 26:5, 389-390
    CrossRef

12. 12

    E Caumes, M Danis. (2001) Nouvelles indications de l’ivermectine. La Revue de Médecine Interne 22:4, 379-384
    CrossRef

13. 13

    O. Bouchaud, S. Houze, R. Schiemann, R. Durand, P. Ralaimazava, C. Ruggeri, J.-P. Coulaud. (2000) Cutaneous Larva Migrans in Travelers: A Prospective Study, with Assessment of Therapy with Ivermectin. Clinical Infectious Diseases 31:2, 493-498
    CrossRef

14. 14

    E. Caumes. (2000) Treatment of Cutaneous Larva Migrans. Clinical Infectious Diseases 30:5, 811-814
    CrossRef