Their main disadvantages are that they have limited value for multiple lesions and hookworm folliculitis and that they require multiple daily applications for several days.
The main advantage of topical treatments is the absence of systemic side effects. In the other 2 cases, treatment was successful after 2 weeks in 1 case and after 4 weeks in the other.
In the largest such study (98 German patients), thiabendazole ointment (15% thiabendazole and 3% salicylic acid in unguentum alcoholum lanae) was successful in 96 cases (cure rate, 98%) within 10 days. In most patients the pruritus ceased and larval track migration halted within 48 h of treatment. The thiabendazole cream was prepared by crushing 500-mg tablets of thiabendazole in a water-soluble base. In a large study of 53 Canadian patients, in which 15% thiabendazole cream in a water-soluble base was applied to the affected area 2 or 3 times a day for 5 days, all but 1 of the patients were cured. Topical application of a 10%–15% thiabendazole solution/ointment to the affected area was shown decades ago to be efficacious.
Because this method is both ineffective and painful, it should be avoided. In another series, none of 7 patients treated with liquid nitrogen was cured. In 1 series, cryotherapy (repeated applications of liquid nitrogen) was unsuccessful for 6 patients and resulted in severe blistering or ulceration in 2 patients.
GETTING RID OF HOOKWORMS IN HUMANS SKIN
Freezing the leading edge of the skin track with ethylene chloride spray, solid carbon dioxide, or liquid nitrogen rarely works, as the larva is usually located several centimeters beyond the visible end of the trail. The most effective treatment is topical or oral administration of antihelmintic agents, such as albendazole, thiabendazole, and ivermectin. However, optimal management is controversial: in 1 study, 22 German patients with cutaneous larva migrans had received 12 different treatments, including surgery and French brandy, before they were referred to a specialized center. These potential complications, together with the intense pruritus and the duration of the disease, make treatment mandatory.
GETTING RID OF HOOKWORMS IN HUMANS SERIES
In the largest series of cutaneous larva migrans, involving 98 German patients, 20% of the 40 patients tested had hyper-eosinophilia (defined as an eosinophil proportion >7% of the total leukocyte count) the mean eosinophilia level was 5%, and the range was 0%–37%. For example, edema and vesiculobullous reactions were reported in, respectively, 6% and 9% of 67 French patients and 17% and 10% of 60 Canadians. Ĭomplications include impetigo and local or general allergic reactions. In a series of 25 patients treated with a placebo, 12% healed by the end of the first week and 36% by the end of the fourth week the longest period required for spontaneous healing was 11.2 weeks in this series, but the larvae have been known to migrate for up to 1 year. Right, Hookworm folliculitis, an uncommon clinical form of cutaneous larva migrans.Ĭutaneous larva migrans usually heals spontaneously within weeks or months. Left, A cutaneous serpiginous track characteristic of cutaneous larva migrans. Hookworm folliculitis is an uncommon form of cutaneous larva migrans, marked by pustular folliculitis of the buttocks ( figure 1, right). Note that creeping eruptions occur in many other human skin diseases.
Larval migration through the skin is marked by an intensely pruritic, linear, or serpiginous track ( figure 1, left) known as a creeping eruption. The hookworm larva burrows through intact skin but remains confined to the upper dermis, since humans are incidental hosts. Humans are infected in tropical and subtropical areas of endemicity by contact with contaminated soil. These hookworms generally live in the intestines of domestic pets such as dogs and cats and shed their eggs via feces to soil (usually sandy areas of beaches or under houses). It is now easy to treat with new oral antihelmintic agents, which are both well tolerated and effective.Ĭutaneous larva migrans is caused by the larvae of animal hookworms, of which Ancylostoma braziliense is the species most frequently found in humans. Cutaneous larva migrans is the most frequent skin disease among travelers returning from tropical countries.
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