|Year : 1991 | Volume
| Issue : 6 | Page : 305-306
Larva migrans responding to 1% gammexane cream applied under occlusion
Sanjay Singh, SS Pandey
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh S, Pandey S S. Larva migrans responding to 1% gammexane cream applied under occlusion. Indian J Dermatol Venereol Leprol 1991;57:305-6
|How to cite this URL:|
Singh S, Pandey S S. Larva migrans responding to 1% gammexane cream applied under occlusion. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2020 Mar 29];57:305-6. Available from: http://www.ijdvl.com/text.asp?1991/57/6/305/3716
The worms most frequently responsible for larva migrans are Ancylostoma braziliensis, A. caninum, A. ceylanicum and Uncinaria stenocephalia.  These hookworms abound in the intestine of dogs and cats, and their eggs are deposited on the earth in their faces. Filariform larvae emerge under favorable conditions and, if they are unlucky, penetrate the skin of a `dead-end' host-man. A case of larva migrans is described which responded to 1 per cent gammexane cream applied under occlusion.
| Case Report|| |
A 5 year-boy from a village near Varanasi had itchy lichenified plaque behind left lateral malleolus for past 1 month. About 7 to 10 back an elevation had begun at-the lower part of the plaque. It had developed into an itchy, 11 rams long and 3-4 mm wide, tortuous, cord like structure on lateral side of left food [Figure - 1]. Itching was episodic and intense and the elevation progressively increasing at a rate of about 1 to 1.5 centimeters per day. The child used to play barefoot in the fields near his house and was otherwise in good health.
The diagnosis of larva migrans was made and patient was prescribed 1 per cent gammexane cream to be applied over-night daily under polythene occlusion covering the lesion as well as skin upto a few centimeters ahead of its distal end. The lesion disappeared in 1 week, only some hyperpigmentation was left at the site of lichenification.
| Comments|| |
Biopsy of larva migrans is of little value  and impractical  as larvae have advanced beyond the clinical lesion  Fortunately, it is not necessary to recover the organism to make the diagnosis, the clinical appearance is diagnostic.  This can be differentiated from larva current by its much slower rate of advancement.  Topical application of 2 per cent gammexane cream has been used successfully to treat larva migrans. 
Polythene occlusion enhances the penetration of a drug. Presumably penetration of 1 per cent gammexane in this case was enhanced in this way leading to cure. However, as with any other treatment of larva migrans, the possibility of spontaneous recovery can not be ruled out as 25 to 81 per cent of larvae die spontaneously in 4 weeks. 
| References|| |
|1.||Harman R R M : Tropical skin diseases in temperate climates, in : Recent advances in dermatology, Number 4, Editor, Rook A : Churchill Livingstone, Edinburgh, 1977 ; p 91-153. |
|2.||Harman R R M : Parasitic worms and protozoa, in Textbook of Dermatology, Fourth ed., Editors, Rook A. Wilkinson D S, Ebling F J G et al : Oxford University Press, Bombay, 1987; p 987-1029. |
|3.||Lookingbill D P : Principles of clinical diagnosis, in : Dermatology, Second ed., Editors, Moschella S L, Hurley H J, W B Saunders Company, Philadelphia, 1985; p 126-200. |
[Figure - 1]