Medical Student IDs Serpiginous Lesions With VisualDx

Brian T., a student at Providence Health Care in Canada, shares how he used VisualDx to make the right diagnosis of his patient’s lesion:

I was asked to see a patient with serpiginous lesions and did not remember what to think about. Thanks to VisualDx, I was able to correctly diagnosis cutaneous larva migrans!

What is cutaneous larva migrans?

Also known as creeping eruption, creeping verminous dermatitis, sandworm eruption, plumber’s itch, and duck hunter’s itch, cutaneous larva migrans is a parasitic infestation of the epidermis. It is caused by larvae of hookworms that infect domestic dogs and cats or humans. It is usually acquired by walking barefoot on soil or sand contaminated with dog or cat feces containing the larvae. After contact with the skin, larvae penetrate the epidermis and undergo a prolonged migration through the epidermis in a serpiginous, or “snake-like,” fashion.

What should we be aware of when making a diagnosis?

Ask about history of travel. The patient almost always has a history of skin exposure to the ground or sand in warm climates. However, it may be weeks or months before the lesions appear, especially if the weather is cold. (The lesions may erupt during the change of seasons when the temperature rises.)

How can we treat this?

  • Due to the intense pruritus and risk of superinfection, treatment with an antihelminthic is recommended.
  • Topical 10%-15% thiabendazole is an option, but often it must be made to order by the pharmacy.
  • Oral antihistamines and mid- to high-potency topical corticosteroid preparations may be employed for symptomatic relief.
  • Carbon dioxide laser and cryotherapy are physical modalities that may be used to halt larval progression.

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