Treatment of Cutaneous Larva Migrans
For cutaneous larva migrans, treat with either ivermectin 200 μg/kg as a single oral dose OR albendazole 400 mg once daily for 3 days. 1
First-Line Treatment Options
The 2025 UK guidelines provide two equally acceptable first-line regimens 1:
- Ivermectin 200 μg/kg as a single oral dose - This is the most convenient option with excellent efficacy and minimal side effects 1, 2
- Albendazole 400 mg once daily for 3 days - This is the alternative first-line option with comparable efficacy 1, 2
Both regimens are supported by the most recent (2025) guideline evidence and should be considered equivalent in efficacy. The choice between them can be based on availability, patient preference for single-dose versus multi-day therapy, and specific contraindications.
Clinical Context
Cutaneous larva migrans is caused by penetration of skin by dog or cat hookworm larvae and presents with a characteristic self-limiting itchy, serpiginous rash that migrates at 1-2 cm per day 1. The diagnosis is clinical and does not require laboratory confirmation 1.
Extended Treatment Considerations
While the guideline recommends 3 days of albendazole, some clinical evidence suggests that extending albendazole treatment to 7 days (400 mg daily) may reduce treatment failures and recurrences, particularly in patients with multiple or extensive lesions 3, 4. One retrospective study of 78 patients showed 100% cure rate with 7-day therapy, with symptom resolution within 2-3 days for pruritus and 5-7 days for skin lesions 4.
Combination Therapy
For refractory cases or severe presentations, combination therapy with both albendazole and ivermectin has shown success in case reports, though this is not part of standard guideline recommendations 5. This approach may be considered when single-agent therapy fails.
Special Populations
- Pregnancy: Albendazole should be avoided, especially in the first trimester 2. Ivermectin has shown no teratogenicity in limited human data according to the American College of Obstetricians and Gynecologists, though caution is warranted 2
- Breastfeeding: Both medications appear compatible with breastfeeding based on low excretion into breast milk per WHO guidance 2
- Immunocompromised patients: May require more aggressive treatment and closer monitoring 2
Common Pitfalls
- Distinguishing from other larval migrations: Larva currens (Strongyloides) migrates much faster at 5-10 cm per hour versus 1-2 cm per day for cutaneous larva migrans 1
- Treatment duration with albendazole: The standard 3-day course may have a 15-16% failure rate in some series 3, 6, so consider extending to 7 days for multiple or extensive lesions
- Side effects: Thiabendazole (an older alternative) causes frequent side effects and should be avoided when ivermectin or albendazole are available 7, 6