Hookworm-related cutaneous Larva Migrans (HrCLM) is a parasitic, zoonotic, nematode skin infestation that occurs as a result of the penetration and migration of the filariform larvae of animal hookworms (mostly dogs, cats, and livestock) into the epidermis of the skin as a result of contact with soil or feces that harbor the larvae of the parasites [1,2]. The (HrCLM) condition is characterized by a migrating, pruritic, erythematous, serpiginous eruption with a slightly elevated track that moves in an irregular pattern. A secondary bacterial infection may occur due to scratching. Humans get infected when the filariform larvae penetrate into their skin, usually when walking barefoot on soil contaminated with animal feces. The infestation is not reported regularly and is often misdiagnosed [3].

A 32-year-old farmer reported to Yasleem Pharmaceuticals in Dutse, Nigeria, with complaints of itching and an irritating movement of some sort on his left foot. He said that his condition started after walking barefoot on a rice farm some weeks ago. Upon examination, we found a 3–4 cm elevated track with blisters and an erythematous creeping eruption (Figure 1). The patient has not experienced similar creeping eruptions with blisters in the past. A diagnosis of a hookworm-related cutaneous larva migrans was made. An albendazole of 400mg for 7 days was prescribed for the patient to be taken once daily. A week after taking the albendazole, the patient followed up, and we observed that the lesion and the itching had subsided.

Figure 1: Erythematous creeping eruption with blisters (arrowed).

Hookworm-related cutaneous Larva Migrans (HrCLM) is a parasitic zoonotic infestation found mostly in tropical and subtropical countries. HrCLM is endemic in Africa and other developing countries. It occurs as a result of the penetration and migration of the filariform larvae of animal hookworms (mostly dogs, cats, and livestock) into the epidermis of the skin as a result of contact with soil or feces that harbor the larvae of the parasites [1,2]. The HrCLM condition is characterized medically by a migrating, pruritic, erythematous, serpiginous eruption with a slightly elevated track that moves in an irregular pattern. The HrCLM is also called a creeping eruption. Although HrCLM is the syndrome and creeping eruption is the clinical sign, they are often used interchangeably [1,2].

Human beings are an accidental host for the parasites; therefore, the normal development of the parasite would not take place in humans. The larvae are confined to the skin, thus unable to further develop and complete the life cycle, as in dogs, cats, or cattle. Humans are a dead end for the larvae; the larvae creep aimlessly in the epidermis, causing a stinging irritation because the larvae lack the enzymes to invade the dermis [4]. HrCLM may cause secondary bacterial superinfection because of the scratching of the lesion [2]. Humans get infected when the filariform larvae penetrate into their skin, usually when walking barefoot on soil contaminated with animal feces.

The hookworms that commonly cause HrCLM are the hookworms of dogs: Ancylostoma caninum and Uncinaria stenocephala; hookworms of dogs and cats: Ancylostoma braziliensis; hookworms of cattle: Bunostomum phlebotomum; and occasionally the human hookworms: Ancylostoma duodenale, Necator americanus, and Ancylostoma tubaeforme [4].

HrCLM incidence peaks during the rainy season, with an estimated 15% higher infestation rate than in the dry season [1]. This is due to the fact that embryonated eggs and larvae survive better in wet soil than in dry soil and can be dispersed by rainfall. Moreover, there is a greater chance of desiccation of the eggs and larvae during the dry season than during the rainy season [2].

Our patient walked barefoot on a rice farm; he has a higher risk of infestation. The prevalence and risk of HrCLM are higher in individuals whose occupations or hobbies bring them into contact with contaminated soil, especially farmers. Common predilection sites were the feet, legs, ankles, and any part that came into contact with soil that was contaminated with larvae [2].

The level of awareness of the disease is low, is not reported regularly, and is often misdiagnosed for other pruritic skin infections because primary health care workers are not familiar with the infestation [3].

A clinical diagnosis of HrCLM is made in the presence of an erythematous, serpiginous track of a linear movement in the skin with an irritating, itching lesion and a history of exposure. Some patients have increased IgE levels and peripheral eosinophilia [2]. The common drugs used for the treatment of the infestation were antihelminthics such as oral albendazole, ivermectin, and topical thiabendazole [2].

The clinical diagnosis of HrCLM is based on the skin findings and a history of exposure, like walking barefoot. Patients can be successfully treated with albendazole. The HrCLM may be misdiagnosed by health care providers for other skin infestations. Health care workers should therefore familiarize themselves with the infestation. To prevent the infestation, we recommend the deworming of household pets like dogs and cats and livestock like cattle. People should be enlightened on the importance of wearing shoes (footwear). Farmers should be wearing boots and hand gloves on their farms to prevent themselves from being infested.

Informed Consent

Informed consent of the patient was obtained for publication of this report.

Conflict interest

Authors declare no conflict of interest.

1. Leung AK, Barankin B, Hon KL. Cutaneous larva migrans. Recent Pat Inflamm Allergy Drug Discov. 2017; 11: 2-11.
2. Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm related cutaneous larva migrans. Lancet Infect Dis. 2008; 8:302-309.
3. Akwaowo CD, Umoh IO. A case report of cutaneous larvae Migrans with associated fungal Superinfection in Uyo, Nigeria. Int J Trop Dis Health. 2015; 9: 1-4.
4. Robson N. A case of cutaneous larva migrans acquired from soiled toilet floors in urban Kuala Lumpur. Med J Malaysia. 2008; 63.