Indian Journal of Dermatology
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Year : 2006  |  Volume : 51  |  Issue : 4  |  Page : 294
Creeping eruption: A spectacular presentation


Department of Dermatology, RKM Seva Pratisthan and VIMS, UV-24/3C, Udayan, 1050/1, Survey Park, Kolkata - 700 075, WB, India

Correspondence Address:
Sujata Sengupta
Department of Dermatology, RKM Seva Pratisthan and VIMS, UV-24/3C, Udayan, 1050/1, Survey Park, Kolkata - 700 075, WB
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.30301

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How to cite this article:
Sengupta S, Das JK, Gangopadhyay A. Creeping eruption: A spectacular presentation. Indian J Dermatol 2006;51:294

How to cite this URL:
Sengupta S, Das JK, Gangopadhyay A. Creeping eruption: A spectacular presentation. Indian J Dermatol [serial online] 2006 [cited 2019 Sep 15];51:294. Available from: http://www.e-ijd.org/text.asp?2006/51/4/294/30301


Cutaneous larva migrans (LM) or creeping eruption (CE) is a distinct cutaneous eruption caused by hookworms or nematodes Ankylostoma brasiliensis , A. caninum , A. ceylonicum , Uncinaria stenocephala and Bubostomum phlebotomum . Other rare causes are Strongyloides stercoralis , Dirofilaria spp, Spirometra spp, Gnathostoma spp and Loa Loa .[1] These nematodes normally do not parasitize human skin. But the infective larval forms of the dog or cat hookworm may accidentally penetrate the intact exposed skin and then wander through the epidermis.[2] The clinical picture of this accidental human association may rarely be quite awesome as in this particular case.

A 38-year-old male presented with intensely itchy eruptions on both legs and left hand for the past six months. He was a fisherman by profession and spent long hours in the river. There was no history of local trauma, fever or cough and he had no pet animals. His family members did not have any such disease. On examination, we found bilateral, almost symmetrical eruptions on his legs. Tortuous and serpentine tracts and forks were seen traveling in a bizarre pattern, extending from the dorsum of the feet up to the knees [Figure - 1]. Similar tracts were present in the left hand also. Scattered eczematous papules and excoriations due to scratching were found. The baseline laboratory investigations were normal except for a raised eosinophil count. A diagnosis of extensive LM was made on the basis of the history and classical presentation. Since a biopsy of the skin tracts was unlikely to reveal the larva, we did not do it. Ivermectin in the dose of 200 g/kg body weight was prescribed and a partial clinical improvement was seen after three months.

Though the larval forms of CE travel at the rate of few millimeters to three centimeters per day and the disease is self-limiting, extensive involvement may be seen in neglected cases like this. Large numbers of larva may be active at a time forming a disorganized series of loops and tortuous tracts.[1] Unusual forms of LM have been reported by Indian authors before.[2],[3] The striking bilaterally symmetrical eruption on the legs is an additional interesting feature in our case. We are reporting the case because of its spectacular clinical presentation.

 
   References Top

1.Vega-Lopez F, Hay RJ. Parasitic worms and protozoa. In : Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 7th ed. Oxford Blackwell: 2004. p. 32.1-47.  Back to cited text no. 1      
2.Mehta V, Shenoi D. Extensive larva migrans. Indian J Dermatol Venereol Leprol 2004;70:373-4.  Back to cited text no. 2  [PUBMED]  Medknow Journal  
3.Padmavathy L, Rao LL. Cutaneous larva migrans: A case report. Indian J Med Microbial 2005;23:135-6.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  


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