What is the recommended treatment for cutaneous larva migrans?

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, 2

Diagnosis

Cutaneous larva migrans is diagnosed clinically based on the characteristic presentation 1, 2:

• Serpiginous, itchy rash that migrates 1-2 cm per day (much slower than larva currens from Strongyloides, which moves 5-10 cm per hour) 1
• History of skin contact with soil or sand potentially contaminated with dog or cat feces 1
• May be associated with eosinophilia 1

Treatment Algorithm

First-Line Options (Choose One)

Option 1: Ivermectin 1, 2

• Dose: 200 μg/kg as a single oral dose
• Advantages: Single-dose therapy improves compliance
• Highly effective with minimal side effects

Option 2: Albendazole 1, 2

• Dose: 400 mg once daily for 3 days
• Alternative first-line option with equivalent efficacy
• Well-tolerated with minimal side effects

Duration Considerations

While the guideline recommends 3 days of albendazole 1, 2, research evidence suggests that extending albendazole treatment to 7 days (400 mg daily) may reduce recurrence rates in patients with multiple or extensive lesions 3, 4, 5. Studies show 100% cure rates with 7-day regimens and no increased side effects 4, 5. However, the most recent UK guidelines support the shorter 3-day course as adequate 1.

Expected Clinical Response

• Pruritus typically resolves within 2-3 days of starting treatment 4
• Skin lesions disappear within 5-7 days 4
• The condition is self-limiting, but treatment accelerates resolution and prevents bacterial superinfection from scratching 6

Special Populations

Pregnancy: 2

• Albendazole should be avoided, especially in the first trimester
• Ivermectin has shown no teratogenicity in limited human data (per American College of Obstetricians and Gynecologists), though caution is warranted

Breastfeeding: 2

• Both ivermectin and albendazole appear compatible with breastfeeding based on low excretion into breast milk (per World Health Organization)

Immunocompromised patients: 2

• May require more aggressive treatment and monitoring

Important Clinical Distinction

Do not confuse cutaneous larva migrans with human hookworm infection (Ancylostoma duodenale or Necator americanus) 7:

• Human hookworm larvae penetrate skin with minimal symptoms ("ground itch") and migrate internally to cause systemic infection
• Zoonotic hookworm larvae (dog/cat) causing cutaneous larva migrans remain trapped in the epidermis, creating the characteristic serpiginous rash 7

Common Pitfalls

• Bacterial superinfection from scratching is common due to intense pruritus; consider antibiotic coverage if secondary infection is present 6
• Recurrence can occur with inadequate treatment duration, though this is rare with standard regimens 3, 5
• Topical thiabendazole is difficult to obtain in many countries and less effective than oral therapy 8, 6
• Cryotherapy is often ineffective and not recommended 3, 8