Treatment of Cutaneous Larva Migrans
The recommended 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
First-Line Treatment Options
Both of the following regimens are equally acceptable as first-line therapy:
- Ivermectin 200 μg/kg as a single oral dose is highly effective and offers the advantage of single-dose administration 1
- Albendazole 400 mg once daily for 3 days is an alternative first-line option with comparable efficacy 1
The choice between these two options can be based on availability, patient preference for single versus multi-day dosing, and pregnancy status (see special populations below). 1
Extended Treatment Duration for Complex Cases
For patients with multiple and/or extensive lesions, consider extending albendazole treatment:
- Albendazole 400 mg once daily for 7 days achieved 100% cure rates in patients with multiple or diffuse lesions, potentially reducing treatment failures and recurrences sometimes observed with shorter 3-day courses 2, 3
- Symptom resolution typically occurs within 2-3 days for pruritus and 5-7 days for skin lesions 3
- The longer duration does not increase side effects 2
Combination Therapy
Combination therapy with albendazole plus ivermectin may be considered in refractory cases or when treatment failure occurs with monotherapy 4, though this is based on limited case report evidence rather than guideline recommendations.
Special Populations
Pregnancy
- Albendazole should ideally be avoided during pregnancy, especially in the first trimester 1
- Ivermectin has shown no teratogenicity or toxicity in limited human pregnancy data, though caution is still warranted 5
Lactation
- Both medications appear compatible with breastfeeding based on low excretion into breast milk 5
Clinical Pearls
- Diagnosis is primarily clinical based on the characteristic serpiginous, pruritic rash that migrates 1-2 cm per day 1
- The condition is self-limiting but treatment accelerates resolution and relieves symptoms 1
- Prevention involves proper hand hygiene after contact with potentially contaminated soil and wearing shoes in endemic areas 1
- Eosinophilia may be present in some cases but is not required for diagnosis 1
Common Pitfalls
- Avoid using shorter 3-day albendazole courses for extensive disease, as this may lead to treatment failures (15.4% failure rate reported with 3-day regimens) 6
- Do not use topical thiabendazole as first-line therapy when oral options are available, as it is difficult to obtain in many countries and less convenient 2
- Immunocompromised patients may require more aggressive treatment and closer monitoring 1