Synopsis
Identify the characteristic migrating itchy track after contaminated soil or sand exposure, distinguish important mimics, treat promptly, and manage excoriation, bacterial superinfection and special prescribing situations.
- Cutaneous larva migrans is usually caused by dog or cat hookworm larvae, especially Ancylostoma braziliense or A. caninum, penetrating exposed skin contaminated by animal faeces.
- The key feature is an intensely itchy, raised, winding track that advances slowly, commonly about one to two centimetres each day.
- Feet, toes, buttocks, thighs and hands are typical sites after barefoot walking, lying or sitting on warm moist sand or soil.
- Diagnosis is first-line clinical from morphology, migration and exposure; routine biopsy, serology and stool microscopy add little in a typical case.
- First-line oral treatment options are ivermectin 200 micrograms/kg as a single dose or albendazole 400 mg once daily for three days.
- Treat excoriation and bacterial superinfection separately; an antibiotic is not needed for the sterile larval track itself.
- Larva currens moves much faster and signals Strongyloides infection, which has different systemic consequences and must not be relabelled as ordinary beach-acquired disease.
- There is no person-to-person transmission and no routine notification requirement; footwear, barriers on sand and pet faeces control reduce exposure.
Key red flags
Rapidly advancing erythema, severe pain, fever, lymphangitis or purulent discharge suggests secondary bacterial cellulitis rather than uncomplicated larval migration.
A track moving centimetres per hour, especially around the buttocks or trunk, raises concern for Strongyloides larva currens and requires systemic-risk assessment.
Intermittent deep migratory swellings, visceral symptoms or neurological features after raw fish or freshwater exposure suggest gnathostomiasis rather than epidermal hookworm.
Wheeze, breathlessness, fever and pulmonary infiltrates with eosinophilia can represent a rare pulmonary hypersensitivity syndrome or an alternative helminth infection.
Pregnancy, breastfeeding, very young age, low body weight or significant liver disease requires medicine-specific specialist review before ivermectin or albendazole.
Immunosuppression does not make the classic animal-hookworm larvae complete their lifecycle, but it lowers the threshold to investigate Strongyloides and atypical infection.
Increasing warmth, tenderness, diffuse erythema, pus, fever or lymphangitis extends beyond the expected itchy track and needs separate clinical assessment.
Investigation priorities
Combine the slowly advancing serpiginous lesion with direct skin exposure in a compatible environment.
Management branches
An itchy linear or serpiginous eruption develops after beach, soil or animal-associated exposure.
- Record exposure location, date and direct skin contact, then examine the entire skin surface for tracks, papules, burrows, interdigital lesions and bacterial complications.
- Mark or photograph the leading edge and estimate migration speed; ordinary cutaneous larva migrans advances slowly over days rather than racing within hours.
- Ask about gastrointestinal, respiratory, neurological and constitutional symptoms, raw food exposure, immunosuppression and pregnancy before choosing treatment.
- Treat a classic presentation clinically; reserve biopsy, cultures and broader parasite testing for an atypical morphology, systemic features or failure.
The exposure and slowly migrating pruritic track are typical and no red flag suggests a different invasive process.
- Offer ivermectin 200 micrograms/kg orally as a single dose, using actual weight and checking pregnancy, breastfeeding, age, weight and interacting or neurological concerns.
- Alternatively give albendazole 400 mg orally once daily for three days, particularly where