What is the treatment for cutaneous larva migrans?

Treatment of Cutaneous Larva Migrans

The first-line treatment for cutaneous larva migrans is either ivermectin 200 μg/kg as a single oral dose or albendazole 400 mg once daily for 3 days. 1

Clinical Presentation and Diagnosis

• Cutaneous larva migrans presents with a characteristic self-limiting itchy, serpiginous rash that migrates at 1-2 cm per day, caused by penetration of skin by dog/cat hookworm larvae 1
• The condition has a worldwide distribution with predominance in warmer regions 1
• Diagnosis is primarily clinical, based on the characteristic appearance of the rash 1, 2
• The condition may be associated with eosinophilia in some cases 1, 2

Treatment Options

First-line Treatment

• Ivermectin 200 μg/kg as a single oral dose 1

  • Mechanism of action: Binds selectively to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing paralysis and death of the parasite 3
  • Advantages: Single-dose regimen, high efficacy rate (100% in some studies) 4

• Albendazole 400 mg once daily for 3 days 1

  • Alternative first-line option with good efficacy 1
  • May require longer treatment duration than ivermectin 4

Comparative Efficacy

• A randomized trial showed that a single dose of ivermectin (12 mg) had a significantly higher cure rate (100%) compared to a single dose of albendazole (400 mg) with a cure rate of only 46% 4
• For multiple or diffuse lesions, some evidence suggests a longer course of albendazole (400 mg daily for 7 days) may be beneficial to reduce recurrence 5

Treatment Algorithm

1. Confirm diagnosis based on characteristic serpiginous, itchy rash and history of exposure to potentially contaminated soil 1, 2

2. Choose treatment based on availability and patient factors:

   • Preferred option: Ivermectin 200 μg/kg as a single oral dose 1, 4
   • Alternative option: Albendazole 400 mg once daily for 3 days 1

3. For severe or extensive disease:

   • Consider longer duration of albendazole (up to 7 days) 5
   • In cases of treatment failure or recurrence, consider combination therapy with both ivermectin and albendazole 6

4. For secondary bacterial infection:

   • Add appropriate antibiotics to address superinfection caused by scratching 7

Monitoring and Follow-up

• Most cases resolve completely within one week of appropriate treatment 6
• If symptoms persist after initial treatment, consider:
  • Retreatment with the alternative agent 4
  • Extending the duration of treatment 5
  • Combination therapy with both ivermectin and albendazole 6

Prevention

• Regular treatment of dogs and cats with anthelmintic drugs 7
• Avoid direct skin contact with potentially contaminated soil 7
• Proper hand hygiene after contact with dogs or soil potentially contaminated with dog feces 2

Special Considerations

• Immunocompromised patients may require more aggressive treatment and monitoring 2
• Albendazole should ideally be avoided during pregnancy, especially in the first trimester 2