Acta Dermato-Venereologica 99-9CompleteContent | Page 14
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CLINICAL REPORT
Autochthonous Cutaneous Larva Migrans in France and Europe
Pascal DEL GIUDICE 1 , Sophie HAKIMI 2 , Frédéric VANDENBOS 3 , Catherine MAGANA 4 and Thomas HUBICHE 1
1
Infectious Diseases and Dermatology Unit, Hospital of Fréjus-Saint-Raphaël, 2 Private Dermatology Office, Blausasc, 3 The miner’s house
clinic, Vence, and 4 Private Dermatology Office, Enghien-les-Bains, France
Cutaneous larva migrans is a dermatitis, typically acqu-
ired in warm tropical or sub-tropical countries, caused
by migration of the larvae of nematodes (hookworm;
mainly Ancylostoma braziliense and, occasionally, A.
caninum or Uncinaria stenocephala), which are parasi-
tic on animals such as cats and dogs, into the patient’s
skin. The larvae penetrate the skin after contact with
infected soil and cause a typical creeping eruption.
Patients with cutaneous larva migrans seen in Europe
have usually acquired the disease following a stay in a
tropical or sub-tropical area. However, some cases of
cutaneous larval migrans are acquired in Europe. We
report here 5 autochthonous cases in France and give
an overview of European autochthonous cases.
SIGNIFICANCE
Cutaneous larva migrans is a dermatitis acquired in warm
tropical and sub-tropical countries caused by the skin
migration of larvae of animal nematodes. However, some
patients may present a cutaneous larva migrans acquired
locally in Europe. We report herein 5 autochthonous cases
in France and give an overview of the European autochtho-
nous cases published over a period of 25 years.
Acta Derm Venereol 2019; 99: 805–808. Patients with CLM in Europe have typically acquired
the disease after a stay in a tropical or sub-tropical area.
Europe, even Southern Europe, is not an endemic area
for CLM; nevertheless, a few cases of autochthonous
(locally acquired) CLM have been reported in Europe.
We report here 5 autochthonous cases in France and
give an overview of the European autochthonous cases
of the last 25 years.
Corr: Pascal Del Giudice, Infectious Diseases and Dermatology Unit, Hos-
pital of Fréjus-Saint-Raphaël, 240 avenue saint Lambert, FR-83600 Fré-
jus, France. E-mail: [email protected] CASE REPORTS
Key words: cutaneous larva migrans; France; Europe; Ancylos-
toma caninum.
Accepted May 9, 2019; E-published May 10, 2019
C
utaneous larva migrans (CLM) is typically acquired
in warm tropical or sub-tropical countries (1–3).
CLM is a dermatitis caused by migration of the larvae of
nematodes (hookworm; mainly Ancylostoma braziliense
and, occasionally, Ancylostoma caninum or Uncinaria
stenocephala (1–3)), which are parasitic on animals such
as cats and dogs, into the patient’s skin. The larvae pene
trate the skin after contact with infected soil and cause
a typical creeping eruption (1–3). According to Caumes
& Danis (4) a creeping eruption is defined by a linear
or serpiginous cutaneous track that is slightly elevated,
erythematous and mobile. The larvae cannot penetrate
the skin basal membrane, therefore they progress within
the epidermis, and the disease is self-limiting (3). This
eruption must be distinguished from other non-creeping
linear or serpiginous dermatoses, such as superficial
thrombophlebitis, Mondor’s disease, lichen striatus and
other lichenoid eruptions of this type, phytophotoder
matitis, and zoster. Other creeping eruptions caused by
parasites include larva currens, caused by Strongysloides
stercoralis, gnathostomiasis, and Pelodera strongyloides,
but the clinical presentation of these eruptions differs
from typical CLM in most cases and these parasites are
not endemic in France. Topical ivermectin is the most
recent proposed therapeutic option (5, 6).
Case 1: July 2011
A 50-year-old woman was referred with a pruritic skin lesion on
her wrist on 15 July 2011. She had a pruritic serpiginous linear
cutaneous track on the right wrist that had evolved from a palmar
papule within a few days (Fig. 1a). The physical examination
was otherwise unremarkable. She had visited a sandy beach in
Saint-Raphael (Var department) in the South of France on 2 and 9
July 2011 and had lain on towels placed directly on the sand. She
was accompanied by her husband and daughter who were free of
lesions. She had not travelled outside France for the last 2 years.
She preferred not to receive treatment and to wait. On the 19 July
2011, the lesion disappeared spontaneously.
Case 2: August 2013
A 21-year-old man was seen on 21 August 2013 for a pruritic skin
rash on the buttock lasting for 10 days. He used to swim in the
river near Draguignan (Var department) and to lie on the bank of
the river. The patient had been treated with fusidic acid cream with
no effect. Clinical examination revealed an erythematous, crusted
plaque-like eczema. Close examination of the plaque revealed ser
piginous tracks typical of CLM (Fig. 1b). The patient was treated
successfully with a single oral dose of 200 μg/kg ivermectin and
clobetasol cream.
Case 3: August 2015
A 30-year-old man presented on 7 August 2015 with a serpiginous
pruritic track on his back (Fig. 1c) after lying on a sandy beach
at Sainte-Maxime (Var department). He had not travelled outside
France within the past year. He did not recall when the lesion had
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3217
Acta Derm Venereol 2019; 99: 805–808