Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning traveller.
BACKGROUND
Cutaneous larva migrans (CLM) is the result of a nematode infection, and shows a characteristic creeping eruption. As travel to the tropics increases, many British citizens may be returning with this infection, which is often misdiagnosed or treated incorrectly.


OBJECTIVE
To perform a retrospective survey of 44 cases of CLM presenting to the Hospital for Tropical Diseases in London over the last 2 years.


METHODS
Cases were reviewed with regard to patient characteristics, source of infection, source of referral, clinical features and therapy.


RESULTS
Most infections were acquired in Africa (32%), the Caribbean (30%) and South-east Asia (25%), but also in Central and South America. There was a history of exposure to a beach in 95% of patients and the median duration of symptoms was 8 weeks (range 1-104). Lesions mainly affected the feet (39%), buttocks (18%) and abdomen (16%), but the lower leg, arm and face were also affected. Multiple lesions were seen in seven of 44 cases (16%). Laboratory abnormalities were absent in all patients. Of 44 patients seen, four needed no treatment, 28 were cured by a single course of treatment, 11 required a second course of therapy and one patient was treated three times. Thirty-one patients received oral albendazole 400 mg daily for 3-5 days and 24 were cured (77%). Five patients received 10% thiabendazole cream topically for 10 days and four were cured (80%). Four patients received oral thiabendazole 1.5 g daily for 3 days and all required further therapy.


CONCLUSIONS
In view of the range of treatment regimens recorded, a randomized controlled trial comparing topical and systemic therapies is warranted.
Blackwell
V
V
Department of Dermatology, Middlesex Hospital and Hospital for Tropical Diseases, University College London Hospitals Trust, Arthur Stanley House, Tottenham Street, London W1P 9PG, UK.
Vega-Lopez
F
F
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D015766:Albendazole / Q000627:therapeutic use; D000871:Anthelmintics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007815:Larva Migrans / Q000175:diagnosis* / Q000188:drug therapy / Q000635:transmission; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013827:Thiabendazole / Q000627:therapeutic use; D014195:Travel
D000871:Anthelmintics; D015766:Albendazole; D013827:Thiabendazole