Treatment of Cutaneous Larva Migrans
The first-line treatment for cutaneous larva migrans is oral ivermectin 200 μg/kg as a single dose, which offers superior cure rates compared to other treatment options. 1
First-Line Treatment
- Ivermectin: 200 μg/kg orally as a single dose (approximately 12 mg for a 60 kg adult)
Alternative Treatment Options
- Albendazole: 400 mg orally daily for 3 days 3
Clinical Considerations
Patient Presentation
- Characteristic serpiginous, itchy rash migrating at 1-2 cm per day 3
- Most commonly affects feet, buttocks, and abdomen 5
- Often associated with beach exposure (95% of cases) 5
Treatment Selection Algorithm
- For standard cases: Ivermectin 200 μg/kg single dose
- If ivermectin unavailable: Albendazole 400 mg daily for 3 days
- For severe or extensive disease: Consider repeat dose of ivermectin after 1-2 weeks if needed
- For treatment failures: Switch to alternative agent or consider combination therapy 6
Special Populations
- Pregnancy: Avoid ivermectin; use albendazole with caution 1
- Children: Adjust dosing by weight; ivermectin still preferred 1
- Immunocompromised patients: May require extended or repeated treatment courses 1
Treatment Efficacy Comparison
- A randomized trial showed ivermectin (single 12 mg dose) achieved 100% cure rate compared to only 46% with single-dose albendazole (400 mg) 7
- Relapse rates are significantly higher with albendazole single-dose therapy 7
Common Pitfalls
- Misdiagnosis as other dermatological conditions
- Insufficient treatment duration with albendazole (single dose instead of 3-day course)
- Attempting physical treatments like cryotherapy, which are often ineffective 4
- Delaying treatment, which can lead to secondary bacterial infections (impetigo) or allergic reactions 2
Most infections are self-limiting but treatment is recommended due to the intense pruritus, risk of complications, and the typically prolonged course of the disease if left untreated 2.