A characteristic rash

doi:10.1136/bmj.b1451

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E E Craythorne, specialist registrar,
S Wong, specialist registrar,
R Morris Jones, consultant,
A W P du Vivier, consultant

¹Department of Dermatology, King’s College Hospital, London SE5 9RS

Correspondence to: E E Craythorne emma_craythorne{at}hotmail.com

A 53 year old man presented with an itchy, red rash on his lower leg after a trip to Brazil. He recalled having been bitten on the right ankle while on a beach and had covered the bite with a plaster. The initial bite mark on the ankle extended by 1-2 cm per day in a serpiginous pattern across the ankle and up the leg (figure)⇓. Other than intense irritation of the skin, he had no other symptoms and was systemically well.

An itchy rash

Questions

1 What is the diagnosis?
2 What are the differential diagnoses?
3 How is it treated?

Answers

Short answers

1 Cutaneous larva migrans is a common, tropically acquired dermatosis caused by the percutaneous penetration and migration of larvae of nematode parasites.
2 Other infestations—including erythema migrans of Lyme disease, migratory myiasis, and larva currens caused by Strongyloides stercoralis—should be considered.
3 Cutaneous larva migrans is self limiting, but its clinical course is shortened by effective treatment with topical and oral anthelmintics such as albendazole, thiabendazole, and ivermectin.