Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Atypical invasive presentation
Fever, systemic toxicity, rapidly spreading inflammation, marked oedema, pulmonary symptoms, neurological signs or deep migratory swellings are not routine cutaneous larva migrans.
Action: Reassess the diagnosis urgently, culture suspected bacterial infection, evaluate for larva currens, gnathostomiasis or another invasive parasitic disease, and involve dermatology or infection specialists before repeating antiparasitic treatment.
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.
Key red flags
Rapidly advancing erythema, severe pain, fever, lymphangitis or purulent discharge suggests secondary bacterial cellulitis rather than uncomplicated larval migration.
Secondary infection
Increasing warmth, tenderness, diffuse erythema, pus, fever or lymphangitis extends beyond the expected itchy track and needs separate clinical assessment.
Investigation priorities
01
First-line clinical diagnosisFirst stepFirst line
Combine the slowly advancing serpiginous lesion with direct skin exposure in a compatible environment.
Management branches
RECOGNISEConfirm the clinical pattern
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.
FIRST-LINEEradicate epidermal larvae
The exposure and slowly migrating pruritic track are typical and no red flag suggests a different invasive process.
Key medicines
IvermectinGive 200 micrograms/kg orally as a single dose for uncomplicated cutaneous larva migrans; use a specialist-directed repeat dose only for persistent proven migration.
AlbendazoleGive 400 mg orally once daily for three days for uncomplicated cutaneous larva migrans, extending only on specialist advice for extensive or refractory disease.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.