TREATMENT OF CUTANEOUS LARVA MIGRANS WITH ALBENDAZOLE.

PRELIMINARY REPORT.

J a i m e R. T O R R E S R., Angel R. O R I H U E L A ,

David G A R C I A & Salha

ABDUL-HADI.

SUMMARY

T w e n t y three patients w i t h C u t a n e o u s L a r v a M i g r a n s s y n d r o m e were prospec

t i v e l y t r e a t e d w i t h 400 m g / d a y of A l b e n d a z o l e for 3 c o n s e c u t i v e d a y s . C l i n i c a l r e s p o n
se, c o m p l i a n c e a n d t o l e r a n c e w a s e x c e l l e n t . P a t i e n t s w e r e a s y m p t o m a t i c w i t h i n t h e
f i r s t 72 h o u r s of t r e a t m e n t a n d r e c u r r e n c e s d i d n o t o c c u r r e d . P r e l i m i n a r y

results

w i t h t h r e e a d d i t i o n a l p a t i e n t s s u g g e s t t h a t a s i n g l e o r a l 400 m g d o s e m a y b e e f f e c t i v e
as well.
K E Y W O R D S : Cutaneous larva migrans; Treatment; Albendazole.

INTRODUCTION
T h e S y n d r o m e of C u t a n e o u s L a r v a M i g r a n s

MATERIAL AND METHODS

( C L M ) , also k n o w n a s creeping eruption, is a di

s e a s e c o m m o n l y f o u n d i n i n h a b i t a n t s of t r o p i c a l

T w e n t y t h r e e p a t i e n t s ( s e x r a t i o : 13 m a l e s ,

or s u b - t r o p i c a l r e g i o n s of t h e w o r l d . I t i s c a u s e d

10 f e m a l e s ; a g e r a n g e : 4 to 48 y e a r s ) , w i t h t h e

b y t h e p e n e t r a t i o n t h r o u g h t h e s k i n of i n f e c t i v e

c l i n i c a l d i a g n o s i s of C L M s e e n a t t h e o u t p a t i e n t s

larvae from various a n i m a l nematodes. A n c y l o s -

c l i n i c of t h e T r o p i c a l M e d i c i n e I n s t i t u t e of C a r a

t o m a b r a z i l i e n s i s , a h o o k w o r m of c a t s a n d d o g s ,

cas, were prospectively treated w i t h albendazole

is r e s p o n s i b l e for m o s t c a s e s , a l t h o u g h o t h e r n e

(Zentel, S m i t h K l i n e & F r e n c h Laboratories), at

matodes s u c h as A . c a n i n u m , U n c y n a r i a steno-

t h e r a t e of 400 m g p e r d a y i n a s i n g l e o r a l d o s e ,

c e p h a l a a n d B u n o s t o m u n p h l e b o t o m u s are oc

for 3 c o n s e c u t i v e d a y s .

casionally involved .
E a c h patient was evaluated on a daily basis
O r a l t h i a b e n d a z o l e a t t h e d o s e of 25 m g / k g

b y the s a m e p h y s i c i a n d u r i n g t r e a t m e n t a n d twi

p e r d a y for t w o c o n s e c u t i v e d a y s i s c u r r e n t l y

c e a w e e k for t h r e e w e e k s a f t e r w a r d ,

c o n s i d e r e d t h e d r u g of c h o i c e . A l t e r n a t i v e l y ,

to e v a l u a t e c l i n i c a l r e s p o n s e . E f f i c a c y w a s c l a s s i

to

in

order

p i c a l a p p l i c a t i o n of a n a q u e o u s 10% s u s p e n s i o n

f i e d a c c o r d i n g to t h e t i m e n e c e s s a r y for

of t h e c o m p o u n d (500 m g p e r 5 m l ) or a 0.5 g

s y m p t o m s a n d l e s i o n s to c l e a r u p a n d t h e o c c u r

tablet triturated with 5 g petroleum jelly, has

r e n c e or n o t of r e c u r r e n c e s a f t e r e n d i n g t h e r a p y ,

been a d v o c a t e d as e q u a l l y effective a n d essen

4

t i a l l y d e v o i d e d of t o x i c s i d e e f f e c t s .

the

a s f o l l o w s : E x c e l l e n t ( d i s a p p e a r a n c e of a l l b a s e
l i n e s i g n s a n d s y m p t o m s r e l e v a n t to t h e l e s i o n s ) ;

A d d r e s s for c o r r e s p o n d e n c e : S a l h a A b d u l H a d i . I n s t i t u t o de M e d i c i n a T r o p i c a l , U n i v e r s i d a d C e n t r a l de V e n e z u e l a , A p a r t a d o
2109, C a r a c a s , V e n e z u e l a .

T O R R E S

R., J .R.; O R I H U E L A , A. R.; G A R C I A ,

with Albendazole. Preliminary report.

D. & A B D U L - H A D I , S . T r e a t m e n t of c u t a n e o u s l a r v a

migrans

R e v . I n s t . M e d . t r o p . S o P a u l o , 31 ( 1 ) : 56 5 8 , 1 9 8 9 .

Good (remission but without complete

disap

DISCUSSION

p e a r a n c e of a l l b a s e l i n e s i g n s a n d s y m p t o m s rel e v a n t to t h e l e s i o n s ) ; a n d R e g u l a r or P o o r (no

W l t e n l a r v a e f r o m c o m m o n c a t or d o g h o o k -

r e m i s s i o n of b a s e l i n e s i g n s a n d s y m p t o m s or re-

w o r m s p e n e t r a t e t h e s k i n of a n " a b n o r m a l " h o s t ,

c u r r e n c e of o r i g i n a l l e s i o n s d e s p i t e t h e r a p y ) .

s u c h as m a n , they m a y undergo prolonged mig r a t i o n s for w e e k s or m o n t h s i n t h e e p i d e r m i s

Four patients had undergone previous un-

a n d leave pruritic, elevated, serpiginous, erythe-

s u c c e s s f u l c o u r s e s of t o p i c c a r b o n d i o x i d e s n o w

m a t o u s t r a i l s a l o n g t h e p a t h of t h e i r m i g r a t i o n .

and/or oral therapy with mebendazole without

A s e n s a t i o n of t i n g l i n g or i t c h i n g a t t h e s i t e of

apparent

penetration

improvement.

is recalled b y m a n y patients. I t is

t h e n f o l l o w e d b y t h e a p p e a r a n c e of a r e d , p r u r i t i c
C u t a n e o u s t r a c t s per p a t i e n t r a n g e d bet-

p a p u l e w i t h i n a few d a y s . C u t a n e o u s t r a i l s d e v e -

w e e n 1 a n d 14; l e n g t h of e v o l u t i o n r a n g e d b e t

l o p a s t h e l a r v a e m i g r a t e a t a r a t e of 1 to 2 c m / d a y

w e e n 2 a n d 10 d a y s ; m o s t l e s i o n s w e r e l o c a t e d

i n the s t r a t u m g e r m i n a t i v u m , w i t h the

i n t h e feet (82.6%) o r h a n d s ( 1 7 . 4 % ) , a n d o c c a s i o

a s a f l o o r a n d t h e s t r a t u m g r a n u l o s u m a s a roof.

corium

nally in other areas. Whenever s e c o n d a r y bacte

rial infection was apparent, coverage with a
broad spectrum oral antibiotic

( c e f a d r o x i l , 500

m g B I D / d a y V O ) , w a s g i v e n for o n e w e e k a l s o .

A Loeffler's like s y n d r o m e h a s been observ e d i n a s i g n i f i c a n t p e r c e n t a g e ( u p to 5 0 % ) of

p a t i e n t s w i t h c r e e p i n g eruption. T r a n s i e n t eosinophilic infiltration o c c u r s in the lesion. A slight

A s t h i a b e n d a z o l e has

become unavailable

i n m a n y c o u n t r i e s of t h e w o r l d a n d s i n c e o t h e r
s u g g e s t e d a l t e r n a t i v e s , s u c h as o r a l or

cept in those w i t h Leoffler's s y n d r o m e .

topical

m e b e n d a z o l e , h a v e n o t l i v e d u p to e a r l y e x p e c t a 5

t i o n s , a n y a d d i t i o n to t h e t h e r a p e u t i c a l a r m a m e n t a r i u m a g a i n s t C L M will certainly be m o s t
w e l l c o m e . T h e r e f o r e , w e d e c i d e d to e v a l u a t e t h e
c l i n i c a l e f f i c a c y of a l b e n d a z o l e , a b r o a d s p e c trum antihelmintic

e o s i n o p h i l i c l e u k o c y t o s i s d e v e l o p s less often, ex-

which has shown larvicidal

3

activity against h u m a n and animal hookworms .

I n the western h e m i s p h e r e , A . b r a z i l i e n s e
is d i s t r i b u t e d m o s t h e a v i l y i n the S o u t h e r n U n i t e d S t a t e s , c o a s t a l r e g i o n s of M e x i c o a n d C e n t r a l
A m e r i c a ; a s w e l l a s i n t r o p i c a l or

sub-tropical

a r e a s of S o u t h A m e r i c a . F a v o r a b l e c o n d i t i o n s
for d e v e l o p m e n t

of l a r v a e t y p i c a l l y

include

m o i s t a n d w a r m s a n d y s o i l , l o a m or h u m u s h e a
v i l y c o n t a m i n a t e d w i t h d o g s o r c a t s feces.

RESULTS
A l l p a t i e n t s s h o w e d a n e x c e l l e n t c l i n i c a l response. I m p r o v e m e n t w a s noticed w i t h i n the first
24 h o u r s ; p r o g r e s s i o n of t h e c u t a n e o u s t r a c t a n d
s e n s a t i o n of l a r v a l m o v e m e n t d i s a p p e a r e d after
48 h o u r s a n d m o s t p a t i e n t s

were b a s i c a l l y

a s y m p t o m a t i c after 72 h o u r s .
Controls performed
post-treatment

T r a d i t i o n a l t h e r a p y i n c l u d e s f r e e z i n g of t h e
area s u r r o u n d i n g the l e a d i n g trail w i t h ethyl chlor i d e s p r a y or c a r b o n d i o x i d e s n o w . H o w e v e r ,
it i s i m p r a c t i c a l i n p a t i e n t s w i t h m u l t i p l e l e s i o n s
a n d d o e s n o t a l w a y s p r o v i d e p e r m a n e n t relief,
since larvae m a y be several centimeters in adv a n c e of t h e t r a i l ' s e n d i n a n y d i r e c t i o n .

u p to the t h i r d w e e k

did not revealed any evidence

of l a r v a l a c t i v i t y i n a l l p a t i e n t s , r e g a r d l e s s o f t h e

W h e n a v a i l a b l e , o r a l or t o p i c a l

thiabenda-

z o l e r e m a i n s t h e t r e a t m e n t of c h o i c e . I f t h e s t a n r
d a r d 25 m g / k g / d a y o r a l d o s e i s n o t e f f e c t i v e , i t

o r i g i n a l n u m b e r of l e s i o n s .

m a y be d o u b l e d a n d repeated.
C o m p l i a n c e a n d t o l e r a n c e w e r e g o o d . N o tox i c s i d e effects w e r e n o t i c e d d u r i n g t h e

period

of o b s e r v a t i o n .

Recent experimental studies suggest that

various broad spectrum antihelmintics, such as
levamizole, thiabendazole, oxfendazole, fenben-

Three additional patients that received only

dazole a n d flubendazole are active a g a i n s t A .

o n e s i n g l e 400 m g d o s e of a l b e n d a z o l e s h o w e d

c a n i n u m l a r v a e i n t h e s k e l e t a l m u s c l e of m i c e .

the s a m e excellent c l i n i c a l evolution aforemen-

O n the other h a n d , albendazole h a s proved larvi-

tioned.

cidal against N. americanus in h u m a n volun-

T O R R E S

R . , J . R.; O R I H U E L A ,A. R.; G A R C I A , D. &

with A l b e n d a z o l e . P r e l i m i n a r y report.

A B D U L - H A D I , S. Treatment

of c u t a n e o u s l a r v a m i g r a n s

R e v . I n s t . M e d . t r o p . S o P a u l o , 31 ( 1 ) : 5 6 - 5 8 , 1 9 8 9 .

t e e r s e x p e r i m e n t a l l y e x p o s e d to t r a n s c u t a n e o u s
3

infection with 8 day-old larvae .

tres p a c i e n t e s adicionales, sugieren que l a dosis

n i c a d e 400 m g p u e d e s e r i g u a l m e n t e e f e c t i v a .

O u r r e s u l t s i n d i c a t e t h a t a l b e n d a z o l e 400

REFERENCES

m g / d a y for t h r e e d a y s r e p r e s e n t s a c o n v e n i e n t ,
e f f e c t i v e a n d s a f e a l t e r n a t i v e to

thiabendazole

i n t h e t r e a t m e n t of C L M . F u r t h e r s t u d i e s
n e c e s s a r y to e v a l u a t e w h e t h e r a s i n g l e d o s e

1.

are

B E A V E R , P . C . L a r v a M i g r a n s . E x p . P a r a s i t . , 5: 587 594,
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2.

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RESUMEN
3.

C L I N E , B . L . , L I T T L E , M. D . ; B A R T H O L O M E W , R . K .
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Migratria con Albendazol. Reporte

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Amer

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L a respuesta

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6.

W R I G H T , D . O . & G O L D , E . M. L o e f f l e r ' s s y n d r o m e
associated with creeping eruption.

Arch, intern.

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