Hookworm‐Related Cutaneous Larva Migrans

Abstract

Cutaneous larva migrans (CLM) is the most frequent travel‐associated skin disease of tropical origin. 1,2 This dermatosis first described as CLM by Lee in 1874 was later attributed to the subcutaneous migration of Ancylostoma larvae by White and Dove in 1929. 3,4 Since then, this skin disease has also been called creeping eruption, creeping verminous dermatitis, sand worm eruption, or plumber’s itch, which adds to the confusion. It has been suggested to name this disease hookworm‐related cutaneous larva migrans (HrCLM). 5 Although frequent, this tropical dermatosis is not sufficiently well known by Western physicians, and this can delay diagnosis and effective treatment. Indeed, misdiagnosis or inappropriate treatment affects 22% to 58% of the travelers with CLM. 6–8 In one case report, the time lag between the onset of disease and the diagnosis was 22 months. 9 Five large (>40 patients each) published studies of imported cases of CLM in returning travelers have greatly helped improve knowledge of this disease. 2,6–8,10 This is particularly true as regards its natural history and response to treatment in short‐term travelers without possibility of recontamination. We reviewed the epidemiological, clinical, and therapeutic data drawn from studies of CLM in travelers. The aim of this review was to contribute to a better definition and description of the disease known as HrCLM. HrCLM is one of the leading causes of dermatologic disorders observed in ill returned travelers. 1,2,11 Risk factors for developing HrCLM have specifically been investigated in one outbreak in Canadian tourists: less frequent use of protective footwear while walking on the beach was significantly associated with a higher risk of developing the disease, with a risk ratio of 4. Moreover, affected patients were somewhat younger than unaffected travelers (36.9 vs 41.2 yr, p = 0.014). There was no correlation between the reported amount of time … Corresponding Author: Eric Caumes, MD, Departement des Maladies Infectieuses et Tropicales, Hopital Pitie‐Salpetriere, 45‐83 Bld de l’hopital, F‐75013 Paris, France. E‐mail: eric.caumes{at}psl.aphp.fr