Acta Dermato-Venereologica 99-9CompleteContent | Page 14

805 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