Indian Journal of Dermatology
CORRESPONDENCE COLUMN
Year
: 2007  |  Volume : 52  |  Issue : 3  |  Page : 165--166

Creeping eruption: A spectacular presentation


Sujata Sengupta, Jayanta Kumar Das, Asok Gangopadhyay 
 UV-24/3C, Udayan, 1050/1, Survey Park, Kolkata - 700 075, WB, India

Correspondence Address:
Sujata Sengupta
UV-24/3C, Udayan, 1050/1, Survey Park, Kolkata - 700 075, WB
India




How to cite this article:
Sengupta S, Das JK, Gangopadhyay A. Creeping eruption: A spectacular presentation.Indian J Dermatol 2007;52:165-166


How to cite this URL:
Sengupta S, Das JK, Gangopadhyay A. Creeping eruption: A spectacular presentation. Indian J Dermatol [serial online] 2007 [cited 2020 Jul 3 ];52:165-166
Available from: http://www.e-ijd.org/text.asp?2007/52/3/165/35358


Full Text

Cutaneous larva migrans (LM) or creeping eruption (CE) is a distinct cutaneous eruption caused by the hookworms or nematodes such as Ankylostoma brasiliensis , A. caninum , A. ceylonicum , Uncinaria stenocephala and Bubostomum phlebotomum . It is rarely caused by Strongyloides stercoralis , Dirofilaria spp., Spirometra spp., Gnathostoma spp. and Loa Loa . [1] These nematodes normally do not parasitize human skin. However, 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 noteworthy as in this particular case.

A 38-year-old male presented with intensely itchy eruptions on both the 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 diseases. On examination, we found bilateral and 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 the biopsy of the skin tracts is unlikely to reveal the larva, we did not perform it. An ivermectin dose of 200 g/kg of body weight was prescribed, and a partial clinical improvement was observed after 3 months.

Although the larval forms of CE travel at the rate of few millimeters to 3cm per day and the disease is self-limiting, extensive involvement may be observed in neglected cases like ours. Large numbers of the 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

1Vega-Lopez F, Hay RJ. Parasitic worms and protozoa. In : Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's textbook of dermatology. 7 th ed. Oxford Blackwell: 2004. p. 32.1-32.47
2Mehta V, Shenoi D. Extensive larva migrans. Indian J Dermatol Venereol Leprol 2004;70:373-4.
3Padmavathy L, Rao LL. Cutaneous larva migrans: A case report. Indian J Med Microbiol 2005;23:135-6.