An 21-year-old surfer presents to your office with a rash that he noted on his foot. The vesicular rash has been present over the last week and has been enlarging.
The rash is shown in picture below:
The most likely diagnosis is
A) Sea lice
B) Cutaneous larva migrans
C) Swimming pool granuloma
D) Jellyfish sting
E) Bathing suit dermatitis
Answer And Discussion:
The answer is B. (Cutaneous larva migrans)
Cutaneous larva migrans is also called the creeping eruption. The causative agent is a hookworm (Ancylostoma duodenale and Necator americanus). The organisms are found in the feces of dogs, cats, cattle, and monkeys. The larvae penetrate human skin (usually the feet after walking barefoot). The condition is more common in gardeners, sea bathers, plumbers, and farmers.
The lesion presents as a thin erythematous, serpiginous, raised tunnellike lesion. The larva die in 4 to 6 weeks; thus, the eruption is typically benign and self limited.
Treatment consists of topical steroids, topical or oral thiabendazole, albendazole, or liquid nitrogen.