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| Fig. 33.1 Creeping eruption. Cutaneous larva migrans due to
canine hookworm. (Courtesy of the Fitzsimons Army Medical Center
teaching files.) |
Properly known as cutaneous larva migrans, and popularly known as “sandworms,” creeping eruption occurs when the
larva of dog and cat hookworms (
Ancylostoma caninum and A. braziliense, respectively) penetrate intact, exposed skin
and begin migrating through the epidermis. The most common location for the eruption is the sole of the foot, although
other sites such as the buttocks, back, and thighs, which may have rested on contaminated sand, are susceptible.
Lacking the enzymes necessary to penetrate and survive in the deeper dermis, the larvae wander a serpiginous route at
a speed up to 3 cm/day. Clinically, the primary lesion is a pruritic, erythematous, serpiginous burrow (Fig. 33-1). Although
the larvae usually die in 2 to 8 weeks, survival up to 22 months has been reported. Several cases of cutaneous larva
migrans–related erythema multiforme have been reported.
A variety of other animal hookworm species may also cause creeping eruption. Human hookworms may briefly cause
a similar eruption, but the better-adapted parasites soon find their way into the circulation.
Richey TK, Gentry RH, Fitzpatrick JE, et al: Persistent larva cutaneous migrans due to
Ancylostoma, South Med J 89:609–611, 1996.
Vaughan TK, English JC 3rd: Cutaneous larva migrans complicated by erythema multiforme, Cutis 62:33–35, 1998.
