Creeping Eruption, Systemic Therapy

Abstract

Dr. Kirby-Smith and his associates in 1926 (1) first drew attention to this disease and prepared a classic monograph on the subject. Reports since then (2—4) show that cases of creeping eruption have been acquired in every state of the coastal plains extending from New Jersey through Texas. Doubtful cases (5, 6) have been reported in Oklahoma, Kentucky and Manitoba but in neither of the latter two instances was the parasite demonstrated. Some of my patients have acquired the infection in South Carolina and have then gone on a trip before noticing any manifestation of the eruption. By the time the eruption became manifest, at least one of these patients was seen and treated in the state of New York. Such instances (8) will probably be noted more frequently in the future and must be traced back to the original source of infection rather than credit the eruption to the state in which the manifestation first appears. Kirby-Smith (7) saw twenty five hundred cases over a period of years in Jacksonville, Florida. The writer has seen and treated in his own practice not less than an average of a hundred to a hundred and fifty cases of the condition during the past fourteen summers. The incidence of the eruption seems to be somewhat dependent upon the amount of moisture in the soil and the massiveness of exposure to the infection as well as to the patient's coming in contact with damp where stray cats, dogs, and other pets are allowed. The form of creeping eruption discussed in this review is due to the burrowing action of the third stage ifiariform larvae of Ankylostoma braziliense, a hookworm found in dogs and cats. Human infection takes place on exposure to moist sandy soil contaminated b be feces of infected animals. Frequent sources of infection are moist sand above tide h.vel, garden plots and the edges of fresh water lakes. Almost any damp earthy spots providing suitable conditions for the hatching of hookworm larvae and accessible to infected animals may become a source of creeping eruption. The larva enters into the skin of any part of the body but most commonly the hands and feet. The back and buttocks are also frequently the original site of entry. The eruption has been found on all parts of the body. Belding (9) describes the points of invasion as reddish itchy papules, from which develop within two or three days narrow linear, slightly elevated erythematous, serpiginous intracutaneous tunnels formed by the migration of the larvae which may move a distance of inches in a day. Vesicles form along the course of the tunnels and the surface becomes dry and crusty. Itching is intense and scratching often leaves a secondary infection. The disease must be differentiated from similar eruptions. The size of the burrow is dependent in many cases upon the reaction of the host's skin. The papulo-vesicular eruption of ground itch, due to the hookworm, Necator americanus, is readily recognized. In the creeping eruption due to a fly larva of the Gastrophilus group, the lesion is less complex and longer than in infections due to A. braziliense. This eruption has been reported from middle western states and the central part of Canada, but not from the coastal states of the eastern and southern United States. Severe multiple infection of creeping eruptions have been noted, particularly in mechanics who have lain on the damp under automobiles and in plumbers and electricians