Buscar en
Enfermedades Infecciosas y Microbiología Clínica (English Edition)
Toda la web
Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Efficacy of albendazole ointment on cutaneous larva migrans in a 2 years child
Journal Information
Vol. 37. Issue 4.
Pages 281-282 (April 2019)
Vol. 37. Issue 4.
Pages 281-282 (April 2019)
Scientific letter
Full text access
Efficacy of albendazole ointment on cutaneous larva migrans in a 2 years child
Eficacia del albendazol tópico en el tratamiento de la larva cutánea migrans en un niño de 2 años
Visits
...
Fernando Alarcon-Soldevillaa, Francisco Miguel Gonzalez-Valverdeb,c,
Corresponding author
migova67@gmail.com

Corresponding author.
, Eva Cristina Alonso-Osmerd, Ángel López-Ávilaa
a Servicio de Dermatología, Hospital General Universitario Santa María del Rosell, Cartagena, Spain
b Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, Spain
c Departamento de Cirugía, Universidad de Murcia, Murcia, Spain
d Medicina Familiar y Comunitaria, Complejo Hospitalario Universitario de Cartagena, Cartagena, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text

Cutaneous larva migrans is an infestation caused by the penetration and migration in the skin of nematode larvae (geohelminths). The most common aetiological agent is Ancylostoma braziliense, although many other species may be involved, such as Ancylostoma caninum and Uncinaria stenocephala,1 depending on the geographical area. The incidence in Spain has grown, due to the increased numbers of travellers and immigrants from the tropical and subtropical areas in which this condition is endemic.2,3 The clinical presentation, in the form of serpiginous-looking erythematous lesions which move ahead at one end (creeping eruption), is characteristic and makes it easy to diagnose, without the need for biopsy.3–5 The lesion is usually limited to the skin, as humans are an incidental host and the parasite is unable to complete its life cycle in humans.3,5 The course of the infestation is usually benign and, in most cases, self-limiting due to the death of the larva within one to three months.3,4

Intense pruritus, combined with the possibility of complications (impetigo due to scratching and allergic reactions), make treatment a necessity.2 Various different modes of treatment have been used in the management of cutaneous larva migrans, including physical treatments such as cryotherapy on the edge of the lesion, which is often painful and ineffective as monotherapy6; topical treatments such as thiabendazole, which is difficult to find in many countries; and systemic treatments such as albendazole and ivermectin, which are effective but can cause adverse effects such as gastrointestinal discomfort and skin changes. Albendazole can also cause headache, transient alopecia, fever, increased intracranial pressure and elevation of liver enzymes, while ivermectin can cause effects such as tachycardia, hypotension, dizziness and eye symptoms.1,2 The differential diagnosis should be made with other skin lesions such as scabies, larva currens (strongyloidiasis), filariasis (Loa loa, Onchocerca volvulus), gnathostomiasis, paragonimiasis and cutaneous myiasis, fascioliasis, bacterial and fungal skin infections, and contact dermatitis.7

We present the case of a 2-year-old male patient from Senegal weighing 12.5kg with a six-month history of serpiginous and intensely pruritic lesions in both lower limbs and his left buttock, compatible with cutaneous larva migrans (Fig. 1A).

Fig. 1.

(A) In the initial image we can see the sinuous trajectory of translucent brown structures, related to the body of the larva. (B) In subsequent check-ups (day 5 of treatment) an improvement of the lesion can be seen. (C) After 10 days of treatment, the structure is no longer evident, but we see an empty trajectory and clinical improvement.

(0.23MB).

The recommended treatment was a single oral dose of 12mg of ivermectin, which provides cure rates of 81–100%, or albendazole 400mg, which has cure rates of 46–100%.7,8 Both are effective and generally well tolerated drugs, but they can cause adverse effects and should be used with caution orally in young children.

An alternative would have been topical treatment of the affected area with thiabendazole 10–15% in ointment or solution.9 The problem is that this medicinal product is not marketed in Spain, has limited value for multiple lesions and folliculitis caused by helminths, and requires applications three times a day for at least 15 days.7,9 Oral thiabendazole is not very effective when administered as a single dose (cure rate of 68–84%) and is worse tolerated than albendazole or ivermectin.7,8

We decided to use a paste of 10% albendazole prepared by crushing three 400mg tablets in 12g of Vaseline, which was applied three times a day for five days, with which there was obvious improvement (Fig. 1B). To obtain a greater occlusive effect on the lesions and to facilitate adherence to the treatment, we changed the above preparation for an ointment made with three albendazole 400mg tablets diluted in water and combined with lanolin and Vaseline. It was only necessary to apply it twice a day for five more days, enough time to achieve the healing of the lesions (Fig. 1C).

Our findings are consistent with and complement those of other authors who suggest that the topical application of albendazole 10% for ten days, twice or three times a day depending on the type of formulation used, is an effective, safe and accessible treatment option for cutaneous larva migrans in situations where oral treatment is contraindicated.1,2

Funding

No funding was received to write this text.

Conflicts of interest

The authors declare that they have no conflicts of interest.

References
[1]
A.K.C. Leung, B. Barankin, K.L.E. Hon.
Cutaneous larva migrans.
Recent Pat Inflamm Allergy Drug Discov, 11 (2017), pp. 2-11
[2]
E. Caumes.
Efficacy of albendazole ointment on cutaneous larva migrans in 2 young children.
Clin Infect Dis, 38 (2004), pp. 1647-1648
[3]
J. Hernández, E. Pintor, B. Herreros.
Prurito en la planta y el dorso de los pies en una viajera procedente de Centroamérica.
Enferm Infecc Microbiol Clin, 26 (2008), pp. 527-528
[4]
M. Sàbat Santandreu, M. Ribera Pibernat, I. Bielsa Narsol, J. Rex Cavalle, C. Ferrándiz Foraster.
Larva migrans cutánea. Presentación de 8 casos.
Actas Dermosifiliogr, 93 (2002), pp. 443-447
[5]
D.L. Ma, S. Vano-Galvan.
Creeping eruption—cutaneous larva migrans.
N Engl J Med, 374 (2016), pp. e16
[6]
N. Kapadia, T. Borhany, M. Farooqui.
Use of liquid nitrogen and albendazole in successfully treating cutaneous larva migrans.
J Coll Physicians Surg Pak, 23 (2013), pp. 319-321
[7]
C. Sunderkötter, E. von Stebut, H. Schöfer, M. Mempel, D. Reinel, G. Wolf, et al.
S1 guideline diagnosis and therapy of cutaneous larva migrans (creeping disease).
J Dtsch Dermatol Ges, 12 (2014), pp. 86-91
[8]
E. Caumes.
Treatment of cutaneous larva migrans.
Clin Infect Dis, 30 (2000), pp. 811-814
[9]
P.S. Harland, R.H. Meakins, R.H. Jarland.
Treatment of cutaneous larva migrans with local thiabendazole.
Br Med J, 17 (1977), pp. 772

Please cite this article as: Alarcon-Soldevilla F, Gonzalez-Valverde FM, Alonso-Osmer EC, López-Ávila Á. Eficacia del albendazol tópico en el tratamiento de la larva cutánea migrans en un niño de 2 años. Enferm Infecc Microbiol Clin. 2019;37:281–282.

Copyright © 2018. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
Article options
Tools
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos