Treatment for

Cutaneus Larva
Migrans
Mayshia Prazitiya Shakti
1410029050

Pembimbing :
dr. Agnes Kartini, Sp. KK
 Cutaneous larva The hookworm larva
migrans is caused by burrows through intact
the larvae of animal skin but remains
hookworms, of which confined to the upper
Ancylostoma braziliense dermis

Larval migration
through the skin is
Complications include
marked by an intensely
impetigo and local or
pruritic, linear, or
general allergic
serpiginous track
reactions
known as a creeping
eruption

The most effective treatment is

topical or oral administration of
antihelmintic agents, such as
albendazole, thiabendazole, and
ivermectin.
 Topical Treatments
ethylene chloride spray, solid carbon
Freezing dioxide, or liquid nitrogen
cryotherapy
In 1 series, cryotherapy (repeated applications
of liquid nitrogen) was unsuccessful for
6 patients and resulted in severe blistering or
ulceration in 2 patients
10%15% thiabendazole
Thiabendazo solution/ointment
le In the largest such study (98 German patients),
thiabendazole ointment (15% thiabendazole
and 3% salicylic acid in unguentum) was
successful in 96 cases (cure rate, 98%) within 10
days
 The main advantage of topical
treatments is the absence of systemic
side effects
Their main disadvantages are that
they have limited value for multiple
lesions and hookworm folliculitis and
that they require multiple daily
applications for several days.
 Oral Treatments
Most
Most experience
experience in
in the
the oral
oral treatment
treatment of
of
Thiabendazo
Thiabendazo CLM
CLM but
but poorly
poorly effective
effective when
when given
given as
as a
a
le
le single
single dose
dose
only 68% of 28 patients in 1 series were
cured by a single dose of 50 mg/kg
In a study of 138 patients treated with
thiaben- dazole (1.252.5 g/d for 12
days) for various indications, the
following adverse effects occurred:
giddiness (13%54%), nau- sea (49%),
vomiting (2%16%), and headache (7%)
 Table1. Treatment of cutaneous larva
migrans with oral thiabendazole(50
mg/kg/d)
Reference No. Of Treatment Patients
patients healed, no (%)
Stone OJ, Mullins 17 2 hari 13(77)
JF
Arch Dermatol 51 3-4 hari 44(87)
Katz R, Ziegler J, 28 Dosis I 19 (68)
Blank H Dosis 2 21 (75)
Dosis 3 22 (79)
Dosis 4 24 (89)
Thomas J, 25 Dosis 1 21 (84)
Lugagne J, Rosso Dosis 2 23 (92)
AM, et al
 Albendazole
Albendazole is
is a
a third-generation
third-generation
Albendazole
Albendazole heterocyclic
heterocyclic

In 2 of the 3 studies involving tourists,

albendazole failed for 2 of 26 Italian patients
and 6 of 11 French patients , while the
duration of follow-up was not given in the
third study. These findings suggest that for
tourists with cutaneous larva migrans who
are treated with albendazole, the regimen
should be 400800 mg/d for 35 days.
 Table 2. Treatment of cutaneous larva
migrans with oral albendazole
Reference No. Of Treatment Duration Patients
patient of healed,
s treament, no (%)
d
Orihuela AR, Torres JR 8 400 1 8 (100)
Jones SK, Reynolds 6 400 3 6(100)
NJ, Oliwiecki S,
Harman RRM
2 800 3 2 (100)
Williams HC, Monk 5 800 3 4 (100)
B
Coulaud JP, Binet D, 18 400 5 18 (100)
Voyer C, Samson C,
Moreau G, Rossignol JF.
Sanguigni S, Marangi 26 400 5 24 (100)
M, Teggi A, De Rosa F
Caumes E, Carrie`re J, 11 400 1 5 (100)
Datry A, Danis M,
Gentilini M
 avermectin
avermectin B
B derivative,
derivative, is
is active
active against
against
Ivermectin
Ivermectin Onchocerca
Onchocerca volvulus
volvulus and
and other
other
nematodes,
nematodes, including
including gastrointestinal
gastrointestinal
helminths
helminths
Study involved 67 Belgian tourists
treated with a single dose (12 mg) of
ivermectin. Fifty-one patients were
assessable and 48 (94%) were cured; 2
patients relapsed, and treatment failed
in an immunodeficient patient
 Table3. Treatment of cutaneous larva
migrans with a single oral 12 mg dose
of iverectin
Reference No. Of Patients
patients healed, no
(%)
Louis JF, De Quincenet G, Louis JP 8 8 (100)
Louis JF, De Quincenet G, Louis JP 12 12(100)
Caumes E, Carrie`re J, Datry A, 10 10(100)
Danis M, Gentilini M
Caumes E, Carrie`re J, Datry A, 57 56 (100)
Bricaire F, Danis M, Gentilini M
Van den Enden E, Stevens A, 51 48 (100)
Van Gompel
Bouchaud O, Schiemann R, Ralaimzava 59 48(100)
P, Longuet C, Ruggeri C, Coulaud JP
Prevention
the best way to prevent cutaneous larva
migrans is to ban dogs from beaches
it is best to wear shoes when walking in
sandy areas.
When on tropical beaches frequented by
dogs, it is best to lie on sand washed by
the tide or to use a mattress; avoid lying
on dry sand, even on a towel
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