Treatment of Cutaneous Larva Migrans
Recommended First-Line Treatment
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, 2
Treatment Algorithm
Primary Options (Choose One):
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 - Equally effective alternative with good tolerability 1, 2
- Standard 3-day regimen shows 84.6% cure rate 5
- Some evidence suggests extending to 7 days may reduce treatment failures and recurrences, particularly for multiple or extensive lesions 6, 7
- One-week therapy (400 mg/day for 7 days) achieved 100% cure rate in 78 patients with multiple/extensive lesions 7
Clinical Pearls and Pitfalls
Expected Treatment Response:
- Pruritus typically resolves within 2-3 days of starting therapy 7
- Visible skin lesions disappear within 5-7 days 7
- The characteristic serpiginous rash migrates at 1-2 cm per day before treatment 1, 2
Common Pitfalls to Avoid:
- Inadequate treatment duration with albendazole: Using only 3 days may result in 15.4% failure rate; consider 7-day course for multiple or diffuse lesions 6, 7, 5
- Thiabendazole should be avoided: While effective in 85.7% of cases, it causes side effects in 57.1% of patients 5
- Topical treatments are less reliable: Cryotherapy and topical agents are often ineffective and not recommended as first-line 6, 8
Special Populations
Pregnancy:
- Albendazole should be avoided, especially in the first trimester 2
- Ivermectin shows no teratogenicity in limited human data but use with caution 2
Breastfeeding:
- Both ivermectin and albendazole appear compatible with breastfeeding due to low excretion into breast milk 2
Immunocompromised Patients:
- May require more aggressive treatment and closer monitoring 2