Treatment of Larva Migrans
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
Both regimens are equally recommended as first-line therapy by the most recent UK guidelines 1:
- Ivermectin 200 μg/kg PO single dose - This achieves cure rates approaching 95-100% and offers the convenience of single-dose administration 2
- Albendazole 400 mg PO once daily for 3 days - Equally effective alternative with excellent tolerability 1
Clinical Diagnosis and Presentation
Diagnosis is made clinically without need for laboratory confirmation 1:
- Characteristic self-limiting itchy, serpiginous rash migrating at 1-2 cm per day 1
- Caused by penetration of skin by dog/cat hookworm larvae (Ancylostoma braziliense, Ancylostoma caninum) 2
- May be associated with peripheral eosinophilia 1
- Critical distinction: This differs from "ground itch," which is a blister-like eruption at the point of entry of human hookworm larvae (Ancylostoma duodenale/Necator americanus) that proceeds to systemic infection 1, 3
Extended Treatment for Complex Cases
For patients with multiple or extensive lesions, consider extending albendazole to 7 days (400 mg daily), which achieves 100% cure rates and may reduce recurrence risk without increased side effects 2, 4. However, the standard 3-day course remains adequate for most cases 2.
Expected Clinical Response
- Pruritus typically resolves within 2-3 days of treatment 4
- Skin lesions disappear within 5-7 days 4
- Important pitfall: Persistent itching after treatment does not indicate treatment failure—pruritus can persist for several days due to inflammatory response even after successful parasite eradication 2
Special Populations
Pregnancy: 2
- Ivermectin has shown no teratogenicity in limited human data (American College of Obstetricians and Gynecologists), though caution is warranted
- Albendazole should ideally be avoided, especially in the first trimester
Breastfeeding: Both ivermectin and albendazole appear compatible based on low excretion into breast milk (World Health Organization) 2
Renal impairment: No dose adjustments required for ivermectin 2
Severe liver disease: Safety of multiple ivermectin doses not established 2
Visceral Larva Migrans (Toxocariasis)
While the provided evidence focuses primarily on cutaneous larva migrans, visceral larva migrans (caused by Toxocara canis or Toxocara cati) is a distinct entity requiring different management. Based on standard parasitology principles, visceral larva migrans typically requires albendazole 400 mg twice daily for 5 days, though specialist consultation is advisable for confirmed cases given potential for serious organ involvement including ocular and neurologic manifestations.