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Year : 2004  |  Volume : 70  |  Issue : 1  |  Page : 59-60
 

Serpiginous lesion on the abdomen


Urban Health Center, Department of Community Medicine, Rajah Muthiah Medical College, Annamalai University, Annamalai Nagar - 608 002

Correspondence Address:
B-3, RSA Complex, Annamalai University, Annamalai Nagar - 608 002
drellellar@yahoo.com



How to cite this article:
Padmavathy L, Rao L L. Serpiginous lesion on the abdomen. Indian J Dermatol Venereol Leprol 2004;70:59-60


How to cite this URL:
Padmavathy L, Rao L L. Serpiginous lesion on the abdomen. Indian J Dermatol Venereol Leprol [serial online] 2004 [cited 2020 May 31];70:59-60. Available from: http://www.ijdvl.com/text.asp?2004/70/1/59/6828


A 60-year-old retired teacher presented with an intensely pruritic, progressive, serpiginous lesion of six weeks' duration on the anterior abdominal wall. Gardening was his hobby. He gave a history of contact with the soil while changing the mud in pots and while manuring plants. He had a dog as a pet.

Clinical examination revealed a curvilinear, erythematous lesion about 20 cm long on the anterior abdominal wall, healing at one end and progressing at the other [Figure - 1].

Baseline hematological and biochemical investigations were within normal limits.


   What is your diagnosis? Top

diagnosis: creeping eruption

Treatment with oral albendazole and topical cryotherapy resulted in clearance of the lesion in 4 weeks. The pet dog was also de-wormed.

Creeping eruption is a distinctive condition due to numerous etiological agents, like Ankylostoma brazilienses, A. caninum, Uncinaria stenocephala, Gnathostoma sp., Dirofilaria conjunctivae, Capillaria species, etc.[1] Other synonyms of this condition are “cutaneous larva migrans”, “sand worms”, creeping verminous dermatitis, plumber's itch and duck hunter's itch.

Creeping eruption commonly occurs when the larvae of dog or cat hookworms penetrate intact exposed skin and migrate though the epidermis. Lacking the enzymes necessary to penetrate and survive in the deeper dermis, the larvae wander in a serpiginous route at a speed of 3 cm/day and produce the typical lesion.[2] The incubation period ranges from 1 to 6 days.

The most common location for the eruption is the feet, but other sites like buttocks, back, and thighs may also be affected. Larva migrans over the genitalia,[3] oral mucosa,[4] and in a 6-month-old infant[5] have been reported.

Though the condition is self limited, secondary bacterial infection and eczematization can occur. Extensive lesions may be associated with wheezing, dry cough and urticaria. A. caninum larvae can migrate to the small intestine and cause eosinophilc enteritis. Transient eosinophilia has been also reported.[5]

The diagnosis is established by the classic clinical picture. Biopsy is of no utility as the larvae advance ahead of the clinical tract. Epiluminiscence microscopy is an effective non-invasive method to detect the larva and confirm the diagnosis.[6]

The lesions disappear in 2-8 weeks but rarely may persist for 2 years. Useful drugs include topical and oral thiabendazole, mebendazole and ivermectin (150 to 200 mcg/kg as a single dose).[7] 

   References Top

1.Bryceson ADM, Hay RJ. Parasitic worms and protozoa. In: Champion RH, Burton JL, Ebling FJG, editors. Rook/Wilkinsor/ Ebling Textbook of dermatology. 5th ed. Oxford: Blackwell; 1992. p. 1217-64.  Back to cited text no. 1    
2.Jeeffrey I, Meffert. Parasitic infestations. In: Fitzpatrick J, Aeling J, editors. Dermatology secrets. 1st ed. New Delhi, India: Jaypee Brothers; 1997. p. 217.  Back to cited text no. 2    
3.Pavithran K. Larva migrans on the glans penis. Indian J Dermatol Venereol Leprol 1982;48;237-8.  Back to cited text no. 3    
4.Fitzpatrick' Dermatology. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SJ. Dermatology in general medicine. 5th ed. New York: McGraw Hill; 1999. p. 2624-5.  Back to cited text no. 4    
5.Masuria BL, Batra A, Kothiwala RK, Khuller R, Singhi MK, Creeping eruption. Indian J Dermatol Venereol Leprol 1999;65:51  Back to cited text no. 5    
6.Eisher E, Themes M, Worret WI. Cutaneous larva migrans detected by epiluminiscent microscopy. Acta Derm Venereol 1997;77:487-8.  Back to cited text no. 6    
7.Coumas E, Datry A, Paris L, et al. Efficacy of ivermectin in the treatment of cutaneous larva migrans. Arch Dermatol 1992;128:994-5.  Back to cited text no. 7    

 

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