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Patient Story

A mother brought her 18-month-old son to the physician’s office for an itchy rash on his feet and buttocks (Figures 129-1 and 129-2).1 The first physician examined the child and made the incorrect diagnosis of tinea corporis. The topical clotrimazole cream failed. The child was unable to sleep because of the intense itching and was losing weight secondary to his poor appetite. He was taken to an urgent care clinic where the physician learned that the family had returned from a trip to the Caribbean prior to the visit to the first physician. The child had played on beaches that were frequented by local dogs. The physician recognized the serpiginous pattern of cutaneous larva migrans (CLM) and successfully treated the child with oral ivermectin. The child was 15 kg so the dose was 3 mg (0.2 mg/kg), and the tablet was ground up and placed in applesauce.

FIGURE 129-1

The serpiginous rash of cutaneous larva migrans on the foot of an 18-month-old boy after a family trip to the beaches of the Caribbean. (Used with permission from Richard P. Usatine, MD. Usatine RP. A rash on the feet and buttocks. West J Med. 1999;170(6):344-335.)

FIGURE 129-2

Cutaneous larva migrans on the buttocks and thigh of the same boy showing significant excoriations. (Used with permission from Richard P. Usatine, MD. Usatine RP. A rash on the feet and buttocks. West J Med. 1999;170(6):344-335.)


Creeping eruption, Plumber’s itch.


  • Endemic in developing countries, particularly Brazil, India, South Africa, Somalia, Malaysia, Indonesia, and Thailand.2,3

  • Peak incidence in the rainy seasons.3

  • During peak rainy seasons, the prevalence in children is as high as 15 percent in resource poor areas, but much less common in affluent communities in these same countries with only 1 to 2 per 10,000 individuals per year.4

  • In the US, it is found predominantly in Florida, southeastern Atlantic states, and the Gulf Coast.2

  • Children are more frequently affected than adults.4

Etiology and Pathophysiology

  • Caused most commonly by dog and cat hookworms (i.e., Ancylostoma braziliense, Ancylostoma caninum, or Uncinaria stenocephala).4

  • Eggs are passed in cat or dog feces.2

  • Larvae are hatched in moist, warm sand or soil.2

  • Infective stage larvae penetrate the skin.2


The diagnosis is based on history and clinical findings.

Clinical Features

  • Elevated, serpiginous, or linear reddish-brown tracks 1 to 5 cm long (Figures 129-1 to 129-3).2,5

  • Intense pruritus, which often disrupts sleep.3

  • Symptoms last ...

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