A 42-year-old man presented with a 1-week history of intensely pruritic eruption on the dorsum of his right foot. He had gone for a barefoot stroll on the beach a few days before the onset of the rash. The lesion progressed daily, despite the application of antibacterial lotion to the eruption. The physical examination revealed serpiginous, erythematous raised tracts with bulla formation, findings that are clinically diagnostic of cutaneous larva migrans (Panel A). Cutaneous larva migrans is caused by the migration of hookworm larvae in human skin. It is most commonly caused by the hookworm that infects dogs and cats. The parasite's eggs are passed from animal feces into warm, moist soil or sand, where the larvae hatch. Transmission occurs when skin comes in direct contact with contaminated soil or sand. In humans, the larvae are unable to penetrate the basement membrane to invade the dermis, so disease remains limited to the epidermis. Cutaneous larva migrans is self-limited, though effective anthelmintic treatment (with thiabendazole, albendazole, mebendazole, or ivermectin) can diminish symptoms and shorten the duration of disease. Proper footwear is the key to preventing this condition. Two weeks after a course of albendazole, the patient's lesions showed signs of healing, with areas of desquamation and hyperpigmentation (Panel B).
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