Cutaneous Larva Migrans and Hand Peeling
Cutaneous larva migrans does not typically cause peeling of the hands, as it primarily presents with a characteristic serpiginous, itchy rash that migrates at 1-2 cm per day in the areas where larvae penetrate the skin, most commonly affecting the feet, buttocks, and areas in direct contact with contaminated soil. 1
Clinical Presentation of Cutaneous Larva Migrans
Characteristic presentation:
- Serpiginous (snake-like), erythematous, raised tracks in the skin
- Migration rate of 1-2 cm per day
- Intense pruritus (itching) that may interfere with sleep 1, 2
- Most commonly affects feet, buttocks, and areas that contact contaminated soil 3
- Self-limiting but can last for weeks to months without treatment
Common locations:
- Feet and lower extremities (most common)
- Buttocks
- Hands (less common)
- Trunk (less common)
Skin Manifestations of Cutaneous Larva Migrans
- The primary skin manifestation is the serpiginous track, not skin peeling 1
- Secondary manifestations may include:
- Bacterial superinfection due to scratching 2
- Vesicles or papules along the track
- Local edema
- Excoriation from scratching
Differential Diagnosis for Hand Peeling
If a patient presents with peeling of the hands and suspected parasitic infection, consider:
- Contact dermatitis
- Allergic reaction
- Fungal infections (tinea manuum)
- Bacterial infections
- Eczema
- Psoriasis
- Drug reactions
- Exfoliative dermatitis
Treatment of Cutaneous Larva Migrans
If cutaneous larva migrans is diagnosed, treatment options include:
First-line: Ivermectin 200 μg/kg as a single oral dose 1, 3
- Preferred for multiple or diffuse lesions
- Cure rates of 81-100% 4
Alternative: Albendazole 400 mg orally daily for 3 days 1, 3
- Cure rates of 46-100% 3
- Recommended 3-day course to reduce relapse risk
Key Points for Clinicians
- Cutaneous larva migrans is acquired through skin contact with soil contaminated with animal hookworm larvae, particularly from dogs and cats 1
- The diagnosis is primarily clinical, based on the characteristic serpiginous, migratory track and history of exposure 1
- While cutaneous larva migrans can be associated with eosinophilia, it does not cause peeling of the hands 1
- Prevention includes avoiding skin contact with potentially contaminated soil and wearing protective footwear in endemic areas 2
Pitfalls to Avoid
- Misdiagnosing other dermatological conditions as cutaneous larva migrans
- Failing to consider other parasitic infections that may present with different skin manifestations
- Inadequate treatment duration leading to relapse
- Overlooking potential bacterial superinfection requiring antibiotic treatment
In summary, if a patient presents with peeling of the hands, cutaneous larva migrans would not be the likely diagnosis, and other dermatological conditions should be considered.