Cutaneous larva migrans

Infectious MONDO:0018500 Pathograph 7 parasitic infectious disease helminthiasis

Cutaneous larva migrans is a zoonotic hookworm-related dermatosis caused by superficial migration of animal hookworm larvae in human epidermis after exposure to contaminated sand or soil. The disease typically presents with intensely pruritic, erythematous, serpiginous tracks and is usually diagnosed clinically from lesion morphology and exposure history.

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0
Mappings
2
Definitions
0
Inheritance
3
Pathophysiology
1
Histopathology
5
Phenotypes
7
Pathograph
0
Genes
3
Treatments
0
Subtypes
0
Differentials
0
Datasets
0
Trials
0
Models
10
References
1
Deep Research
🏷

Classifications

Harrison's Chapter
infectious disease parasitic infectious disease
📘

Definitions

2
Clinical case definition for cutaneous larva migrans
Cutaneous larva migrans is defined clinically by pruritic, migrating, serpiginous or linear cutaneous tracks after exposure to contaminated sand or soil harboring animal hookworm larvae.
CASE_DEFINITION Symptomatic human infection caused by animal hookworm larvae in skin
Show evidence (1 reference)
PMID:39021742 SUPPORT Human Clinical
"Cutaneous larva migrans (CLM), caused by third-stage filariform larvae of cat and dog hookworms, presents as pruritic, serpiginous tracks upon skin penetration by larvae from contaminated soil."
Supports the causal agent, exposure route, and characteristic clinical morphology.
Clinical diagnostic framework
Diagnosis is usually clinical and based on compatible serpiginous lesions, pruritus, and exposure history; routine investigations are often normal.
DIAGNOSTIC_CRITERIA Routine clinical diagnosis in suspected cases
Show evidence (2 references)
PMID:41948263 SUPPORT Human Clinical
"Diagnosis was established clinically based on characteristic morphology and exposure history."
Supports clinical diagnosis from morphology and exposure history.
PMID:38222776 SUPPORT Human Clinical
"Diagnosis is mainly clinical and routine investigations usually reveal no abnormality."
Supports clinical diagnosis and limited routine laboratory utility.
⚙

Pathophysiology

3
Hookworm larvae penetrate exposed skin
Infective larvae enter through exposed skin after contact with contaminated sand or soil.
skin epidermis link
Downstream
Intraepidermal larval migration Skin penetration enables larval movement within the epidermis.
Show evidence (1 reference)
PMID:39021742 SUPPORT Human Clinical
"Cutaneous larva migrans (CLM), caused by third-stage filariform larvae of cat and dog hookworms, presents as pruritic, serpiginous tracks upon skin penetration by larvae from contaminated soil."
Supports skin penetration by larvae from contaminated soil as the initiating event.
Intraepidermal larval migration
Larvae migrate within the epidermis, producing slowly advancing linear or serpiginous inflammatory tracks.
inflammatory response link ↑ INCREASED
skin epidermis link
Downstream
Eosinophil-rich local inflammation Migrating larvae trigger local inflammatory responses along the track.
Show evidence (1 reference)
PMID:28906088 SUPPORT Human Clinical
"Hookworm-related cutaneous larva migrans (HRCLM) is caused by the penetration and migration in the epidermis of larvae of Ancylostoma braziliense and Ancylostoma caninum."
Supports intraepidermal larval migration as the core mechanism.
Eosinophil-rich local inflammation
Local inflammatory reaction with eosinophils contributes to pruritic and bullous/vesicular lesions in some cases.
eosinophil link
eosinophil chemotaxis link ↑ INCREASED
Show evidence (2 references)
PMID:28906088 SUPPORT Human Clinical
"Cytological examinations of the blisters showed the presence of lymphocytes and neutrophils, with numerous eosinophils."
Supports eosinophil-rich inflammation in bullous HRCLM lesions.
PMID:38222776 SUPPORT Human Clinical
"The larvae of Ancylostoma spp. are common culprits, causing a localized inflammatory reaction as they migrate through the skin."
Supports local inflammation caused by migrating larvae.
✶

Histopathology

1
Larvae or eosinophil-rich inflammation in skin samples
Skin scraping, blister cytology, or biopsy may identify larvae or eosinophil-rich inflammation when confirmation is needed.
Show evidence (2 references)
PMID:22556085 SUPPORT Human Clinical
"Viable hookworm larvae were found by microscopic examination of a skin scraping from follicular lesions."
Supports microscopic confirmation from skin scraping in a patient with HRCLM.
PMID:28906088 SUPPORT Human Clinical
"Cytological examinations of the blisters showed the presence of lymphocytes and neutrophils, with numerous eosinophils."
Supports eosinophil-rich inflammatory cytology in bullous HRCLM lesions.
⬡

Pathograph

Use the checkboxes to hide or show graph categories. Hover nodes for evidence and cross-linked metadata.
Pathograph: causal mechanism network for Cutaneous larva migrans Interactive directed graph showing how pathophysiology mechanisms, phenotypes, genetic factors and variants, experimental models, environmental triggers, and treatments relate through causal and linked edges.
●

Phenotypes

5
Blood 1
Increased eosinophil count Increased total eosinophil count (HP:0001880)
Show evidence (2 references)
PMID:39633595 PARTIAL Human Clinical
"Ultrasound and MRI did not reveal any parasites, but fluctuations in eosinophils, IgE and IgA levels were observed during treatment."
Supports eosinophil changes as a laboratory feature observed in a treated CLM case.
PMID:36865421 PARTIAL Human Clinical
"Loeffler's syndrome (LS) is a transient respiratory ailment characterised by pulmonary infiltration along with peripheral eosinophilia and commonly follows parasitic infestation."
Supports peripheral eosinophilia in a rare systemic complication reported with multifocal CLM.
Cardiovascular 1
Erythematous serpiginous tracks COMMON Erythema (HP:0010783)
Show evidence (2 references)
PMID:37921817 SUPPORT Human Clinical
"It is characterized by erythematous, twisting, and linear plaques that can migrate to adjacent skin."
Supports migrating erythematous linear plaques as characteristic CLM morphology.
PMID:28906088 SUPPORT Human Clinical
"These tracks may be single or multiple, serpiginous or linear, ramified and intertwined, accompanied by pruritus."
Supports serpiginous or linear track morphology.
Integument 2
Pruritus VERY_FREQUENT Pruritus (HP:0000989)
Show evidence (2 references)
PMID:22087341 SUPPORT Human Clinical
"Intense pruritus, sleep disturbance (due to itching) and the feeling of shame were the most frequent skin disease-associated life quality restrictions (reported by 93.4%, 73.6%, and 64.8% of the patients, respectively)."
Supports pruritus as common and clinically impactful in an endemic-community cohort.
PMID:38222776 SUPPORT Human Clinical
"The lesion gradually expanded, forming a serpiginous erythema, and became intensely pruritic."
Supports intense pruritus in a pediatric case.
Bullous or vesicular lesions OCCASIONAL Abnormal blistering of the skin (HP:0008066)
Show evidence (2 references)
PMID:28906088 SUPPORT Human Clinical
"Atypical clinical presentations of HRCLM are currently more frequent than in the past."
Supports atypical presentations in HRCLM.
PMID:28906088 SUPPORT Human Clinical
"The infestation was characterized by single or multiple blisters, round or oval in shape, of different size, with a clear serous fluid."
Supports bullous lesions as a documented atypical CLM manifestation.
Nervous System 1
Sleep disturbance due to itching COMMON Insomnia (HP:0100785)
Show evidence (1 reference)
PMID:22087341 SUPPORT Human Clinical
"Intense pruritus, sleep disturbance (due to itching) and the feeling of shame were the most frequent skin disease-associated life quality restrictions (reported by 93.4%, 73.6%, and 64.8% of the patients, respectively)."
Supports sleep disturbance caused by itching as a common quality-of-life restriction.
💊

Treatments

3
Oral ivermectin
Action: pharmacotherapy MAXO:0000058
Agent: ivermectin ↗
Oral ivermectin is a first-line anthelmintic treatment; some patients require repeat doses.
Target Phenotypes: Pruritus ↗ Erythematous serpiginous tracks ↗
Show evidence (3 references)
PMID:37921817 SUPPORT Human Clinical
"Oral ivermectin, the preferred first-line treatment for cutaneous larva migrans, was administered in combination with triamcinolone."
Supports ivermectin as preferred first-line therapy.
PMID:10987711 SUPPORT Human Clinical
"The cure rate after a single dose of ivermectin was 77%."
Supports efficacy of single-dose ivermectin in a prospective traveler cohort.
PMID:10987711 SUPPORT Human Clinical
"In 14 patients, 1 or 2 supplementary doses were necessary, and the overall cure rate was 97%."
Supports repeat dosing when single-dose therapy is insufficient.
Oral albendazole
Action: pharmacotherapy MAXO:0000058
Agent: albendazole ↗
Albendazole is an anthelmintic alternative used for CLM, including pediatric cases.
Target Phenotypes: Pruritus ↗ Erythematous serpiginous tracks ↗
Show evidence (2 references)
PMID:38222776 SUPPORT Human Clinical
"Treatment options include albendazole or ivermectin, with preventive measures emphasizing hygiene, footwear use, and pet deworming."
Supports albendazole as a treatment option.
PMID:28906088 SUPPORT Human Clinical
"All patients were successfully treated with oral albendazole."
Supports oral albendazole efficacy in bullous HRCLM case-series patients.
Combined albendazole and ivermectin for refractory CLM
Action: pharmacotherapy MAXO:0000058
Agent: albendazole ↗ ivermectin ↗
Combination therapy may be considered for refractory or relapsed CLM, but broader use remains investigational.
Show evidence (2 references)
PMID:39021742 PARTIAL Human Clinical
"This report highlights the potential of combined albendazole-ivermectin therapy in managing CLM amid emerging antihelminthic resistance, suggesting that its broader application warrants further investigation."
Supports combination therapy as promising but not yet established for broad use.
DOI:10.3390/tropicalmed10060163 PARTIAL Human Clinical
"For relapsed CLM we now recommend a combination of ivermectin and albendazole therapy."
Supports combination therapy specifically in relapsed or refractory CLM.
🌍

Environmental Factors

2
Barefoot exposure around dogs
Barefoot walking in dog-contaminated environments increases exposure risk.
Show evidence (1 reference)
PMID:38222776 SUPPORT Human Clinical
"The patient's family had poor socioeconomic conditions, and the child frequently walked barefoot in an area with many domestic and stray dogs."
Supports barefoot exposure around domestic and stray dogs as a concrete risk context.
Tropical and subtropical environmental exposure
CLM is associated with tropical and subtropical exposure, but cases can be imported or occur outside traditional endemic regions.
Show evidence (2 references)
PMID:38222776 SUPPORT Human Clinical
"Cutaneous larva migrans (CLM) is a dermatitis caused by the invasion and migration of parasitic larvae of hookworms, primarily affecting tropical and subtropical regions."
Supports the typical geographic/environmental context.
PMID:37921817 PARTIAL Human Clinical
"Although cutaneous larva migrans has traditionally been considered a tropical disease, clinicians should be cognizant of its expanding geographic spread."
Supports awareness of cases outside classic tropical settings without quantifying expansion.
{ }

Source YAML

click to show 
name: Cutaneous larva migrans
creation_date: "2026-05-06T23:27:19Z"
updated_date: "2026-05-06T23:46:46Z"
category: Infectious
description: >-
  Cutaneous larva migrans is a zoonotic hookworm-related dermatosis caused by
  superficial migration of animal hookworm larvae in human epidermis after
  exposure to contaminated sand or soil. The disease typically presents with
  intensely pruritic, erythematous, serpiginous tracks and is usually diagnosed
  clinically from lesion morphology and exposure history.
disease_term:
  preferred_term: cutaneous larva migrans
  term:
    id: MONDO:0018500
    label: cutaneous larva migrans
parents:
- parasitic infectious disease
- helminthiasis
synonyms:
- creeping eruption
- ground itch
- dew itch
- hookworm-related cutaneous larva migrans
- serpiginous linear dermatitis
references:
- reference: DOI:10.1007/s40475-021-00239-0
  title: Cutaneous Larva Migrans
  found_in:
  - Cutaneous_Larva_Migrans-deep-research-falcon.md
- reference: DOI:10.7759/cureus.104834
  title: 'Imported Cutaneous Larva Migrans in an Adolescent Traveler: A Case Report From Chile'
  found_in:
  - Cutaneous_Larva_Migrans-deep-research-falcon.md
- reference: DOI:10.1097/ms9.0000000000001512
  title: 'Cutaneous larva migrans in a child: a case report and review of literature'
  found_in:
  - Cutaneous_Larva_Migrans-deep-research-falcon.md
- reference: DOI:10.3390/tropicalmed10060163
  title: 'Cutaneous Larva Migrans Refractory to Therapy with Ivermectin: Case Report and Review of Implicated Zoonotic Pathogens, Epidemiology, Anthelmintic Drug Resistance and Therapy'
  found_in:
  - Cutaneous_Larva_Migrans-deep-research-falcon.md
- reference: DOI:10.5001/omj.2028.07
  title: 'Cutaneous Larva Migrans Outbreak in Seeb Wilaya: A Case Series'
  found_in:
  - Cutaneous_Larva_Migrans-deep-research-falcon.md
- reference: DOI:10.5070/d329461906
  title: Cutaneous larva migrans in the northeastern US
  found_in:
  - Cutaneous_Larva_Migrans-deep-research-falcon.md
- reference: DOI:10.1111/j.1708-8305.2007.00148.x
  title: Hookworm-Related Cutaneous Larva Migrans
  found_in:
  - Cutaneous_Larva_Migrans-deep-research-falcon.md
- reference: DOI:10.1371/journal.pntd.0001355
  title: Life Quality Impairment Caused by Hookworm-Related Cutaneous Larva Migrans in Resource-Poor Communities in Manaus, Brazil
  found_in:
  - Cutaneous_Larva_Migrans-deep-research-falcon.md
- reference: DOI:10.1086/313942
  title: 'Cutaneous Larva Migrans in Travelers: A Prospective Study, with Assessment of Therapy with Ivermectin'
  found_in:
  - Cutaneous_Larva_Migrans-deep-research-falcon.md
- reference: DOI:10.7759/cureus.64665
  title: 'Successful Treatment of Cutaneous Larva Migrans With Combined Albendazole and Ivermectin Therapy: A Report of Two Cases From Sudan'
  found_in:
  - Cutaneous_Larva_Migrans-deep-research-falcon.md
classifications:
  harrisons_chapter:
  - classification_value: infectious disease
    evidence:
    - reference: PMID:41948263
      reference_title: 'Imported Cutaneous Larva Migrans in an Adolescent Traveler: A Case Report From Chile.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Cutaneous larva migrans (CLM) is a parasitic dermatosis caused by the superficial migration of animal hookworm larvae in human skin, typically acquired through contact with contaminated soil or sand in tropical environments."
      explanation: Supports classification as an infectious parasitic dermatosis caused by hookworm larvae.
  - classification_value: parasitic infectious disease
    evidence:
    - reference: PMID:38222776
      reference_title: 'Cutaneous larva migrans in a child: a case report and review of literature.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Cutaneous larva migrans (CLM) is a dermatitis caused by the invasion and migration of parasitic larvae of hookworms, primarily affecting tropical and subtropical regions."
      explanation: Supports classification as a hookworm larval parasitic disease.
definitions:
- name: Clinical case definition for cutaneous larva migrans
  definition_type: CASE_DEFINITION
  description: >-
    Cutaneous larva migrans is defined clinically by pruritic, migrating,
    serpiginous or linear cutaneous tracks after exposure to contaminated sand or
    soil harboring animal hookworm larvae.
  scope: Symptomatic human infection caused by animal hookworm larvae in skin
  evidence:
  - reference: PMID:39021742
    reference_title: 'Successful Treatment of Cutaneous Larva Migrans With Combined Albendazole and Ivermectin Therapy: A Report of Two Cases From Sudan.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous larva migrans (CLM), caused by third-stage filariform larvae of cat and dog hookworms, presents as pruritic, serpiginous tracks upon skin penetration by larvae from contaminated soil."
    explanation: Supports the causal agent, exposure route, and characteristic clinical morphology.
- name: Clinical diagnostic framework
  definition_type: DIAGNOSTIC_CRITERIA
  description: >-
    Diagnosis is usually clinical and based on compatible serpiginous lesions,
    pruritus, and exposure history; routine investigations are often normal.
  scope: Routine clinical diagnosis in suspected cases
  evidence:
  - reference: PMID:41948263
    reference_title: 'Imported Cutaneous Larva Migrans in an Adolescent Traveler: A Case Report From Chile.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Diagnosis was established clinically based on characteristic morphology and exposure history."
    explanation: Supports clinical diagnosis from morphology and exposure history.
  - reference: PMID:38222776
    reference_title: 'Cutaneous larva migrans in a child: a case report and review of literature.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Diagnosis is mainly clinical and routine investigations usually reveal no abnormality."
    explanation: Supports clinical diagnosis and limited routine laboratory utility.
infectious_agent:
- name: Ancylostoma braziliense
  infectious_agent_term:
    preferred_term: Ancylostoma braziliense
    term:
      id: NCBITaxon:369059
      label: Ancylostoma braziliense
  description: Dog and cat hookworm species molecularly confirmed in human hookworm-related cutaneous larva migrans.
  evidence:
  - reference: PMID:22556085
    reference_title: Molecular characterization of Ancylostoma braziliense larvae in a patient with hookworm-related cutaneous larva migrans.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Amplification and sequencing of the internal transcribed spacer 2 allowed the specific identification of the larvae as Ancylostoma braziliense."
    explanation: Molecular identification directly supports A. braziliense as a causative organism in human CLM.
  - reference: PMID:25146212
    reference_title: '[Cutaneous larva migrans after a trip to the Caribean].'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous larva migrans is a parasitic disease caused by Ancylostoma braziliense and Ancylostoma caninum larvae, which is transmitted by contact with sand infested with these parasites."
    explanation: Supports A. braziliense as one of the principal hookworm causes.
- name: Ancylostoma caninum
  infectious_agent_term:
    preferred_term: Ancylostoma caninum
    term:
      id: NCBITaxon:29170
      label: Ancylostoma caninum
  description: Dog hookworm species implicated in hookworm-related cutaneous larva migrans.
  evidence:
  - reference: PMID:28906088
    reference_title: 'Bullous cutaneous larva migrans: case series and review of atypical clinical presentations.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Hookworm-related cutaneous larva migrans (HRCLM) is caused by the penetration and migration in the epidermis of larvae of Ancylostoma braziliense and Ancylostoma caninum."
    explanation: Supports A. caninum as a causative hookworm species for HRCLM.
- name: Ancylostoma ceylanicum
  infectious_agent_term:
    preferred_term: Ancylostoma ceylanicum
    term:
      id: NCBITaxon:53326
      label: Ancylostoma ceylanicum
  description: Zoonotic hookworm species included among Ancylostoma spp. that can cause cutaneous larva migrans.
  evidence:
  - reference: PMID:38500436
    reference_title: Ecoepidemiology of Ancylostoma spp. in Urban-Marginal and Rural Sectors of the Ecuadorian Coast and Prevalence of Cutaneous Larvae Migrans.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "BACKGROUND Ancylostoma spp., including A. duodenale, A. braziliense, A. caninum, and A. ceylanicum, are hookworms that are transmitted from infected soil and by contact with domestic animals and rodent hosts, and can cause systemic disease and cutaneous larva migrans."
    explanation: Supports A. ceylanicum as an Ancylostoma species capable of causing cutaneous larva migrans.
- name: Uncinaria stenocephala
  infectious_agent_term:
    preferred_term: Uncinaria stenocephala
    term:
      id: NCBITaxon:125367
      label: Uncinaria stenocephala
  description: Zoonotic hookworm species reported among causes of cutaneous larva migrans.
  evidence:
  - reference: PMID:38680772
    reference_title: 'Cutaneous Larva Migrans (CLM) may not be easy to diagnose: a case report and narrative review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "It is caused by different types of hookworm, such as Ancylostoma braziliense, Ancylostoma caninum, and Uncinaria stenocephala."
    explanation: Supports U. stenocephala as a reported hookworm cause of CLM.
transmission:
- name: Contact with contaminated sand or soil
  description: >-
    Human infection follows bare-skin exposure to sand or soil contaminated with
    infective animal hookworm larvae, especially in tropical travel or endemic
    settings.
  evidence:
  - reference: PMID:41948263
    reference_title: 'Imported Cutaneous Larva Migrans in an Adolescent Traveler: A Case Report From Chile.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous larva migrans (CLM) is a parasitic dermatosis caused by the superficial migration of animal hookworm larvae in human skin, typically acquired through contact with contaminated soil or sand in tropical environments."
    explanation: Supports contaminated soil or sand contact as the acquisition route.
  - reference: PMID:25146212
    reference_title: '[Cutaneous larva migrans after a trip to the Caribean].'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous larva migrans is a parasitic disease caused by Ancylostoma braziliense and Ancylostoma caninum larvae, which is transmitted by contact with sand infested with these parasites."
    explanation: Independently supports sand-associated transmission.
- name: Dog and cat hookworm environmental contamination
  description: >-
    Dogs and cats are definitive hosts for implicated hookworms, contaminating
    environments where bare skin contact allows larval penetration.
  evidence:
  - reference: PMID:25146212
    reference_title: '[Cutaneous larva migrans after a trip to the Caribean].'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Dogs and cats are the definitive hosts."
    explanation: Supports the animal reservoir for environmental contamination.
environmental:
- name: Barefoot exposure around dogs
  presence: PRESENT
  description: Barefoot walking in dog-contaminated environments increases exposure risk.
  evidence:
  - reference: PMID:38222776
    reference_title: 'Cutaneous larva migrans in a child: a case report and review of literature.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The patient's family had poor socioeconomic conditions, and the child frequently walked barefoot in an area with many domestic and stray dogs."
    explanation: Supports barefoot exposure around domestic and stray dogs as a concrete risk context.
- name: Tropical and subtropical environmental exposure
  presence: PRESENT
  description: CLM is associated with tropical and subtropical exposure, but cases can be imported or occur outside traditional endemic regions.
  evidence:
  - reference: PMID:38222776
    reference_title: 'Cutaneous larva migrans in a child: a case report and review of literature.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous larva migrans (CLM) is a dermatitis caused by the invasion and migration of parasitic larvae of hookworms, primarily affecting tropical and subtropical regions."
    explanation: Supports the typical geographic/environmental context.
  - reference: PMID:37921817
    reference_title: Cutaneous larva migrans in the northeastern US.
    supports: PARTIAL
    evidence_source: HUMAN_CLINICAL
    snippet: "Although cutaneous larva migrans has traditionally been considered a tropical disease, clinicians should be cognizant of its expanding geographic spread."
    explanation: Supports awareness of cases outside classic tropical settings without quantifying expansion.
progression:
- phase: Post-exposure incubation and lesion onset
  notes: Lesions may appear after return from travel, with a long and variable incubation in some patients.
  evidence:
  - reference: PMID:10987711
    reference_title: 'Cutaneous larva migrans in travelers: a prospective study, with assessment of therapy with ivermectin.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "After the patients had returned from their destinations, 55% had lesions occur within a mean of 16 days (range, 1-120 days; >1 month in 7 patients)."
    explanation: Supports variable post-exposure timing of lesion onset in travelers.
- phase: Self-limited cutaneous disease with morbidity
  notes: Disease is often confined to skin but can cause substantial itch-related morbidity and secondary complications.
  evidence:
  - reference: PMID:22087341
    reference_title: Life quality impairment caused by hookworm-related cutaneous larva migrans in resource-poor communities in Manaus, Brazil.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The disease causes intense pruritus and is associated with important morbidity."
    explanation: Supports clinically meaningful morbidity despite cutaneous localization.
  - reference: PMID:38222776
    reference_title: 'Cutaneous larva migrans in a child: a case report and review of literature.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Complications may include secondary bacterial infections, allergies, and rare migration to internal organs."
    explanation: Supports recognized complications from CLM.
pathophysiology:
- name: Hookworm larvae penetrate exposed skin
  description: Infective larvae enter through exposed skin after contact with contaminated sand or soil.
  locations:
  - preferred_term: skin epidermis
    term:
      id: UBERON:0001003
      label: skin epidermis
  downstream:
  - target: Intraepidermal larval migration
    description: Skin penetration enables larval movement within the epidermis.
    evidence:
    - reference: PMID:18626615
      reference_title: '[Cutaneous larva migrans].'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "The characteristic manifestation is a gyrated, serpiginous and in some cases vesicular erythema, which appears after penetration of the epidermis by the parasite and the subsequent intraepidermal migration of the larva."
      explanation: Supports the transition from penetration to intraepidermal larval migration.
  evidence:
  - reference: PMID:39021742
    reference_title: 'Successful Treatment of Cutaneous Larva Migrans With Combined Albendazole and Ivermectin Therapy: A Report of Two Cases From Sudan.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous larva migrans (CLM), caused by third-stage filariform larvae of cat and dog hookworms, presents as pruritic, serpiginous tracks upon skin penetration by larvae from contaminated soil."
    explanation: Supports skin penetration by larvae from contaminated soil as the initiating event.
- name: Intraepidermal larval migration
  description: Larvae migrate within the epidermis, producing slowly advancing linear or serpiginous inflammatory tracks.
  locations:
  - preferred_term: skin epidermis
    term:
      id: UBERON:0001003
      label: skin epidermis
  biological_processes:
  - preferred_term: inflammatory response
    term:
      id: GO:0006954
      label: inflammatory response
    modifier: INCREASED
  downstream:
  - target: Eosinophil-rich local inflammation
    description: Migrating larvae trigger local inflammatory responses along the track.
    evidence:
    - reference: PMID:38222776
      reference_title: 'Cutaneous larva migrans in a child: a case report and review of literature.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "The larvae of Ancylostoma spp. are common culprits, causing a localized inflammatory reaction as they migrate through the skin."
      explanation: Supports inflammation caused by larval migration through skin.
  evidence:
  - reference: PMID:28906088
    reference_title: 'Bullous cutaneous larva migrans: case series and review of atypical clinical presentations.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Hookworm-related cutaneous larva migrans (HRCLM) is caused by the penetration and migration in the epidermis of larvae of Ancylostoma braziliense and Ancylostoma caninum."
    explanation: Supports intraepidermal larval migration as the core mechanism.
- name: Eosinophil-rich local inflammation
  description: Local inflammatory reaction with eosinophils contributes to pruritic and bullous/vesicular lesions in some cases.
  cell_types:
  - preferred_term: eosinophil
    term:
      id: CL:0000771
      label: eosinophil
  biological_processes:
  - preferred_term: eosinophil chemotaxis
    term:
      id: GO:0048245
      label: eosinophil chemotaxis
    modifier: INCREASED
  evidence:
  - reference: PMID:28906088
    reference_title: 'Bullous cutaneous larva migrans: case series and review of atypical clinical presentations.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cytological examinations of the blisters showed the presence of lymphocytes and neutrophils, with numerous eosinophils."
    explanation: Supports eosinophil-rich inflammation in bullous HRCLM lesions.
  - reference: PMID:38222776
    reference_title: 'Cutaneous larva migrans in a child: a case report and review of literature.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The larvae of Ancylostoma spp. are common culprits, causing a localized inflammatory reaction as they migrate through the skin."
    explanation: Supports local inflammation caused by migrating larvae.
phenotypes:
- name: Pruritus
  category: Dermatologic
  frequency: VERY_FREQUENT
  description: Itching is a dominant symptom and major driver of morbidity and sleep disturbance.
  phenotype_term:
    preferred_term: Pruritus
    term:
      id: HP:0000989
      label: Pruritus
  evidence:
  - reference: PMID:22087341
    reference_title: Life quality impairment caused by hookworm-related cutaneous larva migrans in resource-poor communities in Manaus, Brazil.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Intense pruritus, sleep disturbance (due to itching) and the feeling of shame were the most frequent skin disease-associated life quality restrictions (reported by 93.4%, 73.6%, and 64.8% of the patients, respectively)."
    explanation: Supports pruritus as common and clinically impactful in an endemic-community cohort.
  - reference: PMID:38222776
    reference_title: 'Cutaneous larva migrans in a child: a case report and review of literature.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The lesion gradually expanded, forming a serpiginous erythema, and became intensely pruritic."
    explanation: Supports intense pruritus in a pediatric case.
- name: Erythematous serpiginous tracks
  category: Dermatologic
  frequency: COMMON
  description: Slowly migrating erythematous linear or serpiginous tracks are the characteristic skin lesion.
  phenotype_term:
    preferred_term: Erythematous serpiginous tracks
    term:
      id: HP:0010783
      label: Erythema
  evidence:
  - reference: PMID:37921817
    reference_title: Cutaneous larva migrans in the northeastern US.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "It is characterized by erythematous, twisting, and linear plaques that can migrate to adjacent skin."
    explanation: Supports migrating erythematous linear plaques as characteristic CLM morphology.
  - reference: PMID:28906088
    reference_title: 'Bullous cutaneous larva migrans: case series and review of atypical clinical presentations.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "These tracks may be single or multiple, serpiginous or linear, ramified and intertwined, accompanied by pruritus."
    explanation: Supports serpiginous or linear track morphology.
- name: Bullous or vesicular lesions
  category: Dermatologic
  frequency: OCCASIONAL
  description: Bullous or vesicular forms are atypical presentations of hookworm-related cutaneous larva migrans.
  phenotype_term:
    preferred_term: Bullous or vesicular cutaneous lesions
    term:
      id: HP:0008066
      label: Abnormal blistering of the skin
  evidence:
  - reference: PMID:28906088
    reference_title: 'Bullous cutaneous larva migrans: case series and review of atypical clinical presentations.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Atypical clinical presentations of HRCLM are currently more frequent than in the past."
    explanation: Supports atypical presentations in HRCLM.
  - reference: PMID:28906088
    reference_title: 'Bullous cutaneous larva migrans: case series and review of atypical clinical presentations.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The infestation was characterized by single or multiple blisters, round or oval in shape, of different size, with a clear serous fluid."
    explanation: Supports bullous lesions as a documented atypical CLM manifestation.
- name: Sleep disturbance due to itching
  category: Neurologic
  frequency: COMMON
  description: Itch-related sleep disturbance is a major quality-of-life burden in endemic-community patients.
  phenotype_term:
    preferred_term: Sleep disturbance due to itching
    term:
      id: HP:0100785
      label: Insomnia
  evidence:
  - reference: PMID:22087341
    reference_title: Life quality impairment caused by hookworm-related cutaneous larva migrans in resource-poor communities in Manaus, Brazil.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Intense pruritus, sleep disturbance (due to itching) and the feeling of shame were the most frequent skin disease-associated life quality restrictions (reported by 93.4%, 73.6%, and 64.8% of the patients, respectively)."
    explanation: Supports sleep disturbance caused by itching as a common quality-of-life restriction.
- name: Increased eosinophil count
  category: Hematologic
  description: Blood eosinophil abnormalities may occur in CLM cases and in rare Loffler syndrome presentations.
  phenotype_term:
    preferred_term: Increased eosinophil count
    term:
      id: HP:0001880
      label: Increased total eosinophil count
  evidence:
  - reference: PMID:39633595
    reference_title: Consideration of Diagnostic Methods for Cutaneous Larva Migrans in the Sole of an 8-Year-Old Boy.
    supports: PARTIAL
    evidence_source: HUMAN_CLINICAL
    snippet: "Ultrasound and MRI did not reveal any parasites, but fluctuations in eosinophils, IgE and IgA levels were observed during treatment."
    explanation: Supports eosinophil changes as a laboratory feature observed in a treated CLM case.
  - reference: PMID:36865421
    reference_title: "Loeffler's Syndrome and Multifocal Cutaneous Larva Migrans: Case report of an uncommon occurrence and review of the literature."
    supports: PARTIAL
    evidence_source: HUMAN_CLINICAL
    snippet: "Loeffler's syndrome (LS) is a transient respiratory ailment characterised by pulmonary infiltration along with peripheral eosinophilia and commonly follows parasitic infestation."
    explanation: Supports peripheral eosinophilia in a rare systemic complication reported with multifocal CLM.
histopathology:
- name: Larvae or eosinophil-rich inflammation in skin samples
  description: Skin scraping, blister cytology, or biopsy may identify larvae or eosinophil-rich inflammation when confirmation is needed.
  diagnostic: true
  evidence:
  - reference: PMID:22556085
    reference_title: Molecular characterization of Ancylostoma braziliense larvae in a patient with hookworm-related cutaneous larva migrans.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Viable hookworm larvae were found by microscopic examination of a skin scraping from follicular lesions."
    explanation: Supports microscopic confirmation from skin scraping in a patient with HRCLM.
  - reference: PMID:28906088
    reference_title: 'Bullous cutaneous larva migrans: case series and review of atypical clinical presentations.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cytological examinations of the blisters showed the presence of lymphocytes and neutrophils, with numerous eosinophils."
    explanation: Supports eosinophil-rich inflammatory cytology in bullous HRCLM lesions.
diagnosis:
- name: Clinical morphology and exposure history
  description: Diagnosis is usually made from pruritic serpiginous lesions and a compatible exposure history.
  evidence:
  - reference: PMID:41948263
    reference_title: 'Imported Cutaneous Larva Migrans in an Adolescent Traveler: A Case Report From Chile.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Diagnosis was established clinically based on characteristic morphology and exposure history."
    explanation: Supports clinical diagnosis without routine invasive testing.
- name: Microscopic confirmation when sampled
  description: Skin scraping or biopsy can confirm hookworm larvae when morphology is atypical or diagnostic uncertainty persists.
  evidence:
  - reference: PMID:22556085
    reference_title: Molecular characterization of Ancylostoma braziliense larvae in a patient with hookworm-related cutaneous larva migrans.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "We report a case of hookworm-related cutaneous larva migrans diagnosed microscopically."
    explanation: Supports microscopy as a confirmatory approach in selected cases.
treatments:
- name: Oral ivermectin
  description: Oral ivermectin is a first-line anthelmintic treatment; some patients require repeat doses.
  treatment_term:
    preferred_term: pharmacotherapy
    term:
      id: MAXO:0000058
      label: pharmacotherapy
    therapeutic_agent:
    - preferred_term: ivermectin
      term:
        id: CHEBI:6078
        label: ivermectin
  target_phenotypes:
  - preferred_term: Pruritus
    term:
      id: HP:0000989
      label: Pruritus
  - preferred_term: Erythematous serpiginous tracks
    term:
      id: HP:0010783
      label: Erythema
  evidence:
  - reference: PMID:37921817
    reference_title: Cutaneous larva migrans in the northeastern US.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Oral ivermectin, the preferred first-line treatment for cutaneous larva migrans, was administered in combination with triamcinolone."
    explanation: Supports ivermectin as preferred first-line therapy.
  - reference: PMID:10987711
    reference_title: 'Cutaneous larva migrans in travelers: a prospective study, with assessment of therapy with ivermectin.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The cure rate after a single dose of ivermectin was 77%."
    explanation: Supports efficacy of single-dose ivermectin in a prospective traveler cohort.
  - reference: PMID:10987711
    reference_title: 'Cutaneous larva migrans in travelers: a prospective study, with assessment of therapy with ivermectin.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "In 14 patients, 1 or 2 supplementary doses were necessary, and the overall cure rate was 97%."
    explanation: Supports repeat dosing when single-dose therapy is insufficient.
- name: Oral albendazole
  description: Albendazole is an anthelmintic alternative used for CLM, including pediatric cases.
  treatment_term:
    preferred_term: pharmacotherapy
    term:
      id: MAXO:0000058
      label: pharmacotherapy
    therapeutic_agent:
    - preferred_term: albendazole
      term:
        id: CHEBI:16664
        label: albendazole
  target_phenotypes:
  - preferred_term: Pruritus
    term:
      id: HP:0000989
      label: Pruritus
  - preferred_term: Erythematous serpiginous tracks
    term:
      id: HP:0010783
      label: Erythema
  evidence:
  - reference: PMID:38222776
    reference_title: 'Cutaneous larva migrans in a child: a case report and review of literature.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Treatment options include albendazole or ivermectin, with preventive measures emphasizing hygiene, footwear use, and pet deworming."
    explanation: Supports albendazole as a treatment option.
  - reference: PMID:28906088
    reference_title: 'Bullous cutaneous larva migrans: case series and review of atypical clinical presentations.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "All patients were successfully treated with oral albendazole."
    explanation: Supports oral albendazole efficacy in bullous HRCLM case-series patients.
- name: Combined albendazole and ivermectin for refractory CLM
  description: Combination therapy may be considered for refractory or relapsed CLM, but broader use remains investigational.
  treatment_term:
    preferred_term: pharmacotherapy
    term:
      id: MAXO:0000058
      label: pharmacotherapy
    therapeutic_agent:
    - preferred_term: albendazole
      term:
        id: CHEBI:16664
        label: albendazole
    - preferred_term: ivermectin
      term:
        id: CHEBI:6078
        label: ivermectin
  evidence:
  - reference: PMID:39021742
    reference_title: 'Successful Treatment of Cutaneous Larva Migrans With Combined Albendazole and Ivermectin Therapy: A Report of Two Cases From Sudan.'
    supports: PARTIAL
    evidence_source: HUMAN_CLINICAL
    snippet: "This report highlights the potential of combined albendazole-ivermectin therapy in managing CLM amid emerging antihelminthic resistance, suggesting that its broader application warrants further investigation."
    explanation: Supports combination therapy as promising but not yet established for broad use.
  - reference: DOI:10.3390/tropicalmed10060163
    reference_title: 'Cutaneous Larva Migrans Refractory to Therapy with Ivermectin: Case Report and Review of Implicated Zoonotic Pathogens, Epidemiology, Anthelmintic Drug Resistance and Therapy'
    supports: PARTIAL
    evidence_source: HUMAN_CLINICAL
    snippet: "For relapsed CLM we now recommend a combination of ivermectin and albendazole therapy."
    explanation: Supports combination therapy specifically in relapsed or refractory CLM.
epidemiology:
- name: Travel-associated and tropical/subtropical exposure
  description: CLM is associated with tropical/subtropical regions and imported travel cases, but recognition is needed outside classic endemic areas.
  factors:
  - tropical travel
  - beach or sand exposure
  - tropical and subtropical climates
  evidence:
  - reference: PMID:10987711
    reference_title: 'Cutaneous larva migrans in travelers: a prospective study, with assessment of therapy with ivermectin.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Sixty-four patients were enrolled. All were European and had stayed in tropical areas."
    explanation: Supports travel-associated CLM after stays in tropical areas.
  - reference: PMID:41948263
    reference_title: 'Imported Cutaneous Larva Migrans in an Adolescent Traveler: A Case Report From Chile.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "We report the case of a 17-year-old female patient who presented in Chile with pruritic serpiginous skin lesions following recent travel to Brazil."
    explanation: Supports imported CLM after travel to a tropical region.
- name: Quality-of-life burden in endemic communities
  description: CLM can substantially impair dermatology-related quality of life in resource-poor endemic communities.
  factors:
  - intense pruritus
  - sleep disturbance
  - shame
  evidence:
  - reference: PMID:22087341
    reference_title: Life quality impairment caused by hookworm-related cutaneous larva migrans in resource-poor communities in Manaus, Brazil.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Ninety-one point five percent of the study participants showed a considerable reduction of skin disease-associated life quality at the time of diagnosis."
    explanation: Supports substantial quality-of-life burden in a 91-patient endemic-community cohort.
notes: "MONDO:0018500 canonical label was confirmed locally with OAK as 'cutaneous larva migrans'."
📚

References & Deep Research

References

10
DOI:10.1007/s40475-021-00239-0
Cutaneous Larva Migrans
No top-level findings curated for this source.
DOI:10.7759/cureus.104834
Imported Cutaneous Larva Migrans in an Adolescent Traveler: A Case Report From Chile
No top-level findings curated for this source.
DOI:10.1097/ms9.0000000000001512
Cutaneous larva migrans in a child: a case report and review of literature
No top-level findings curated for this source.
DOI:10.3390/tropicalmed10060163
Cutaneous Larva Migrans Refractory to Therapy with Ivermectin: Case Report and Review of Implicated Zoonotic Pathogens, Epidemiology, Anthelmintic Drug Resistance and Therapy
No top-level findings curated for this source.
DOI:10.5001/omj.2028.07
Cutaneous Larva Migrans Outbreak in Seeb Wilaya: A Case Series
No top-level findings curated for this source.
DOI:10.5070/d329461906
Cutaneous larva migrans in the northeastern US
No top-level findings curated for this source.
DOI:10.1111/j.1708-8305.2007.00148.x
Hookworm-Related Cutaneous Larva Migrans
No top-level findings curated for this source.
DOI:10.1371/journal.pntd.0001355
Life Quality Impairment Caused by Hookworm-Related Cutaneous Larva Migrans in Resource-Poor Communities in Manaus, Brazil
No top-level findings curated for this source.
DOI:10.1086/313942
Cutaneous Larva Migrans in Travelers: A Prospective Study, with Assessment of Therapy with Ivermectin
No top-level findings curated for this source.
DOI:10.7759/cureus.64665
Successful Treatment of Cutaneous Larva Migrans With Combined Albendazole and Ivermectin Therapy: A Report of Two Cases From Sudan
No top-level findings curated for this source.

Deep Research

1
Falcon ▸
Cutaneous Larva Migrans (CLM) — Disease Characteristics Research Report
Edison Scientific Literature 36 citations 2026-05-06T19:39:31.437236

Cutaneous Larva Migrans (CLM) — Disease Characteristics Research Report

1. Disease information

Overview / current definition

Cutaneous larva migrans (CLM) is a zoonotic, hookworm-related dermatosis caused by penetration of animal hookworm larvae and their subsequent superficial migration within human skin, producing intensely pruritic, slowly advancing, linear/serpiginous tracks (“creeping eruption”). (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, guarda2026importedcutaneouslarva pages 4-7)

A representative clinical image (serpiginous plaque) and histopathologic confirmation (organism in stratum corneum with eosinophil-rich infiltrate) are shown in the 2023 Dermatology Online Journal report. (johanis2023cutaneouslarvamigrans media 1be38c9c, johanis2023cutaneouslarvamigrans media a6ff90a3)

Synonyms / alternative names

Synonyms used in the clinical/review literature include: hookworm-related cutaneous larva migrans (HrCLM), creeping eruption, zoonotic hookworm infection, serpiginous linear dermatitis, ground itch, sandworm, and plumber’s itch. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3)

Key identifiers (ontology/coding)

  • MeSH: “Cutaneous Larva Migrans” / “Larva Migrans, Cutaneous” is used as an indexed subject term in the biomedical literature; however, the MeSH ID was not present in the retrieved full-text snippets. (guarda2026importedcutaneouslarva pages 4-7)
  • ICD-10/ICD-11: A CLM-specific ICD code was not explicitly stated in the CLM-focused papers retrieved here; several sources refer generally to use of ICD groupings/codes in datasets, but without giving a CLM code. (shrestha2024cutaneouslarvamigrans pages 1-2)
  • MONDO: A MONDO ID was not found in the retrieved evidence.

Evidence source type

The evidence retrieved here is primarily aggregated disease-level reviews, case reports, and case series/outbreak investigations in humans (travel medicine, dermatology), with supporting epidemiologic and quality-of-life cohort studies. (hochedez2007hookwormrelatedcutaneouslarva pages 4-6, hasni2024cutaneouslarvamigrans pages 2-6, schuster2011lifequalityimpairment pages 1-2)

Category Details (concise) Key sources (with DOI/URL + year)
Definition / synonyms Zoonotic, hookworm-related dermatosis caused by intraepidermal migration of non-human hookworm larvae, producing intensely pruritic, linear/serpiginous “creeping” tracks. Synonyms reported in the evidence: hookworm-related cutaneous larva migrans (HrCLM), creeping eruption, zoonotic hookworm infection, serpiginous linear dermatitis, ground itch, sandworm, plumber’s itch. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3) Rodriguez-Morales et al., 2021, https://doi.org/10.1007/s40475-021-00239-0
Key identifiers MeSH term name appears in indexed literature as “Cutaneous Larva Migrans” / “Larva Migrans, Cutaneous” (term name evidenced, numeric ID not found in provided evidence). ICD-10/11 specific code not directly given for CLM in the provided disease-focused sources; broader helminthiasis coding context only. MONDO ID: not found in evidence. (guarda2026importedcutaneouslarva pages 4-7, shrestha2024cutaneouslarvamigrans pages 1-2) Guarda et al., 2026, https://doi.org/10.7759/cureus.104834; Shrestha et al., 2024, https://doi.org/10.1097/ms9.0000000000001512
Main causal organisms Most commonly Ancylostoma braziliense; also Ancylostoma caninum, Ancylostoma ceylanicum, and Uncinaria stenocephala are implicated. Humans are accidental/dead-end hosts; larvae generally do not mature in the intestine. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, currie2025cutaneouslarvamigrans pages 6-7, elmi2025cutaneouslarvamigrans pages 1-3) Rodriguez-Morales et al., 2021, https://doi.org/10.1007/s40475-021-00239-0; Currie et al., 2025, https://doi.org/10.3390/tropicalmed10060163
Typical exposure / risk factors Barefoot walking or lying on contaminated sand/soil, especially beaches and sandboxes; contact with dog/cat feces or untreated pets; muddy/wet soil exposure; travel to tropical/subtropical regions; some occupational exposures (farming, gardening, animal handling). Pediatric risk is prominent in some recent series. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, hasni2024cutaneouslarvamigrans pages 2-6, shrestha2024cutaneouslarvamigrans pages 1-2, johanis2023cutaneouslarvamigrans pages 1-3) Rodriguez-Morales et al., 2021, https://doi.org/10.1007/s40475-021-00239-0; Hasni et al., 2024, https://doi.org/10.5001/omj.2028.07; Shrestha et al., 2024, https://doi.org/10.1097/ms9.0000000000001512; Johanis et al., 2023, https://doi.org/10.5070/d329461906
First-line treatments / example dosing Oral ivermectin is generally preferred first-line: single dose 150–200 µg/kg (adult example 12 mg), repeat if needed. Albendazole is an effective alternative: 400 mg/day for 3–7 days; some reports/series recommend 400 mg once daily for 5 days or 400 mg/day for 1 week. Topical 10% albendazole is an option when oral therapy is contraindicated (e.g., very small children). Cryotherapy is not recommended. (hochedez2007hookwormrelatedcutaneouslarva pages 4-6, johanis2023cutaneouslarvamigrans pages 3-5, hasni2024cutaneouslarvamigrans pages 2-6, hasni2024cutaneouslarvamigrans pages 6-7) Hochedez & Caumes, 2007, https://doi.org/10.1111/j.1708-8305.2007.00148.x; Johanis et al., 2023, https://doi.org/10.5070/d329461906; Hasni et al., 2024, https://doi.org/10.5001/omj.2028.07
Key 2023–2024 developments 2024 Oman urban outbreak/case series linked cases to heavy rainfall, puddles/mud, and recommended surveillance plus municipal/agricultural collaboration; 7/9 cases (78%) were pediatric. 2023 northeastern US case highlighted possible geographic expansion beyond classic tropical zones and climate-linked spread. 2024 Nepal pediatric review emphasized neglected burden, footwear/pet deworming prevention, and pediatric treatment guidance. 2024 Sudan report described successful combination albendazole + ivermectin in 2 cases amid concern about emerging anthelmintic resistance. (hasni2024cutaneouslarvamigrans pages 2-6, hasni2024cutaneouslarvamigrans pages 6-7, johanis2023cutaneouslarvamigrans pages 1-3, shrestha2024cutaneouslarvamigrans pages 3-4, currie2025cutaneouslarvamigrans pages 13-13) Hasni et al., 2024, https://doi.org/10.5001/omj.2028.07; Johanis et al., 2023, https://doi.org/10.5070/d329461906; Shrestha et al., 2024, https://doi.org/10.1097/ms9.0000000000001512; Shamad et al., 2024, https://doi.org/10.7759/cureus.64665

Table: This compact table summarizes the most actionable disease-characteristics evidence for cutaneous larva migrans, including definition, likely identifiers, causes, exposures, treatment, and recent 2023–2024 developments. It is designed for quick knowledge-base population and citation tracing.

2. Etiology

Primary causal factors (infectious)

CLM is most often attributed to zoonotic hookworms of dogs/cats. Reviews emphasize Ancylostoma braziliense as a principal cause, with other implicated species including Ancylostoma caninum and Uncinaria stenocephala. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, elmi2025cutaneouslarvamigrans pages 1-3, currie2025cutaneouslarvamigrans pages 6-7)

Humans are accidental/dead-end hosts; larvae generally do not mature to adult intestinal worms in humans. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3)

Risk factors

Commonly supported risks include: * Bare-skin contact with contaminated sand/soil, especially beaches and sandboxes (walking barefoot, sitting/lying on sand). (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, guarda2026importedcutaneouslarva pages 4-7) * Exposure to dog/cat feces or untreated pets (domestic or stray), especially in resource-poor settings. (shrestha2024cutaneouslarvamigrans pages 1-2, johanis2023cutaneouslarvamigrans pages 1-3) * Occupational soil exposure (e.g., farming, gardening, animal handling). (elmi2025cutaneouslarvamigrans pages 1-3, hasni2024cutaneouslarvamigrans pages 2-6) * Climate/environmental events: a 2024 Oman case series reported a cluster occurring “mainly after periods of rainfall” and noted recent contact with “water puddles or mud” across cases, supporting a role for unusual wet conditions facilitating larval survival/exposure. (hasni2024cutaneouslarvamigrans pages 2-6, hasni2024cutaneouslarvamigrans pages 6-7)

Protective factors

Direct, empirically quantified protective factors were not provided in the retrieved primary studies. Prevention recommendations (Section 13) imply protective effects of consistent footwear and avoidance of direct contact with contaminated sand/soil. (hochedez2007hookwormrelatedcutaneouslarva pages 4-6, shrestha2024cutaneouslarvamigrans pages 1-2)

Genetic risk / protective factors; gene–environment interactions

CLM is not a genetic disease; no causal human genes/variants or gene–environment interaction studies were present in the retrieved evidence.

3. Phenotypes (clinical presentation)

Core clinical phenotypes

The typical presentation is a pruritic, erythematous, linear/serpiginous track that migrates to adjacent skin over time. (johanis2023cutaneouslarvamigrans pages 1-3, guarda2026importedcutaneouslarva pages 4-7)

A 2023 abstract states CLM is “characterized by erythematous, twisting, and linear plaques that can migrate to adjacent skin.” (johanis2023cutaneouslarvamigrans pages 1-3)

Common sites reflect exposure (feet/ankles; sometimes thighs/buttocks). (guarda2026importedcutaneouslarva pages 4-7, johanis2023cutaneouslarvamigrans pages 1-3)

Complications / atypical features

Complications described across recent and foundational sources include: * Secondary bacterial infection due to excoriation/scratching. (guarda2026importedcutaneouslarva pages 4-7, shrestha2024cutaneouslarvamigrans pages 3-4) * Vesiculobullous lesions and folliculitis (including “hookworm folliculitis”/follicular CLM). (johanis2023cutaneouslarvamigrans pages 1-3, hochedez2007hookwormrelatedcutaneouslarva pages 4-6) * Rare systemic manifestations such as Löffler syndrome are mentioned as exceptional. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, hasni2024cutaneouslarvamigrans pages 6-7)

Shrestha et al. (2024) summarizes that routine investigations are often normal and that complications can include secondary bacterial infection, allergy, and rare internal migration; the abstract explicitly notes the lesion was initially misdiagnosed as fungal infection and later became “intensely pruritic.” (shrestha2024cutaneouslarvamigrans pages 1-2)

Onset, severity, progression

CLM is often subacute after exposure, with lesions migrating over days to weeks; the condition is generally self-limited, with larvae dying after several weeks if untreated (reported as ~5–6 weeks in a 2024 review/case report). (shrestha2024cutaneouslarvamigrans pages 3-4)

Quality-of-life impact (statistics)

In a cohort of 91 adults and children in Manaus, Brazil, 91.5% had “a considerable reduction of skin disease-associated life quality” at diagnosis; the most frequent restrictions were intense pruritus (93.4%), sleep disturbance (73.6%), and shame (64.8%). (schuster2011lifequalityimpairment pages 1-2)

QoL improved rapidly with ivermectin; by four weeks, 73.3% considered disease-associated life quality to have returned to normal in the abstract, and detailed results show a median mDLQI drop from 5 to 0 with most participants reporting normalization. (schuster2011lifequalityimpairment pages 1-2, schuster2011lifequalityimpairment pages 3-4)

Suggested HPO terms

(Approximate mappings based on described phenotypes; HPO IDs not retrieved in evidence snippets.) * Serpiginous/migratory skin lesion: Skin lesion, Erythema, Linear skin lesion * Pruritus: Pruritus * Excoriations: Excoriation * Vesicles/bullae: Vesicle, Bulla * Sleep disturbance from itch: Insomnia * Eosinophilia (sometimes): Eosinophilia

4. Genetic / molecular information

No human causal genes, pathogenic variants, modifier genes, or epigenetic mechanisms were identified in the retrieved evidence; CLM is fundamentally an infectious/parasitic exposure-driven condition.

5. Environmental information

Environmental factors

Key environmental determinants are soil/sand contamination with animal feces and conditions that permit larval development/survival in the environment (warmth and moisture). (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, guarda2026importedcutaneouslarva pages 4-7, johanis2023cutaneouslarvamigrans pages 3-5)

A 2024 Oman cluster associated CLM occurrence with unusual rainfall events and muddy/puddled environments, implying environmental moisture as a practical outbreak driver. (hasni2024cutaneouslarvamigrans pages 2-6, hasni2024cutaneouslarvamigrans pages 6-7)

Lifestyle factors

Walking barefoot and lying directly on sand/soil are recurring behavioral risks. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, hochedez2007hookwormrelatedcutaneouslarva pages 4-6)

Infectious agents (pathogens)

Most commonly dog/cat hookworms (Ancylostoma spp.). (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, elmi2025cutaneouslarvamigrans pages 1-3)

6. Mechanism / pathophysiology

Causal chain (trigger → mechanism → phenotype)

  1. Environmental contamination with infective larvae from dog/cat hookworms (feces contaminating sand/soil). (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, guarda2026importedcutaneouslarva pages 4-7)
  2. Skin penetration of infective larvae after bare-skin contact with contaminated substrate. (guarda2026importedcutaneouslarva pages 4-7)
  3. Intraepidermal migration of larvae in humans (who are accidental hosts), producing a moving inflammatory focus along the larval path. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, guarda2026importedcutaneouslarva pages 4-7)
  4. Local inflammation with eosinophils contributes to intense pruritus and visible serpiginous tracks; histology in a U.S. case showed organism in the stratum corneum with a dermal mixed infiltrate including eosinophils. (johanis2023cutaneouslarvamigrans media a6ff90a3)
  5. Downstream consequences: scratching/excoriation → secondary bacterial infection; atypical manifestations include bullae or folliculitis. (guarda2026importedcutaneouslarva pages 4-7, hochedez2007hookwormrelatedcutaneouslarva pages 4-6)

Immune involvement / tissue injury

Evidence supports eosinophil-rich inflammation as a recurring histologic pattern, consistent with helminth-driven type 2 inflammation. (johanis2023cutaneouslarvamigrans media a6ff90a3)

Suggested ontology terms

  • GO (biological process): inflammatory response; eosinophil chemotaxis; leukocyte migration; pruritus (as neuro-immune symptom)
  • CL (cell types): eosinophil; keratinocyte; dermal macrophage; T cell
  • UBERON (anatomy): skin of foot; epidermis; stratum corneum; dermis

Molecular profiling / omics

No transcriptomic/proteomic/metabolomic profiling studies were identified in the retrieved evidence.

7. Anatomical structures affected

Organ/system level

Primary organ: skin (typically exposed areas such as foot/ankle, thigh, buttocks). (guarda2026importedcutaneouslarva pages 4-7, johanis2023cutaneouslarvamigrans pages 1-3)

Tissue/cell level

Primary tissue layer: epidermis/stratum corneum with associated dermal inflammation; organism within stratum corneum is documented histologically. (johanis2023cutaneouslarvamigrans media a6ff90a3)

8. Temporal development

Onset and course

CLM is typically acute-to-subacute following exposure and is often self-limited if untreated, although symptoms can persist for weeks; treatment shortens duration substantially. (hochedez2007hookwormrelatedcutaneouslarva pages 4-6, shrestha2024cutaneouslarvamigrans pages 3-4)

Remission

After ivermectin treatment in a Brazilian cohort, lesion resolution and QoL normalization occurred within weeks for most patients. (schuster2011lifequalityimpairment pages 1-2, schuster2011lifequalityimpairment pages 3-4)

9. Inheritance and population

Epidemiology and geography

CLM is classically associated with tropical/subtropical climates and beach exposure, but recent case literature highlights possible geographic expansion.

A 2023 report emphasized that although CLM is traditionally tropical, clinicians should recognize expanding spread, including a case acquired in New England. (johanis2023cutaneouslarvamigrans pages 1-3)

Recent outbreak/case-series data (2023–2024)

  • Oman (Seeb, Muscat), 2022–2024: “nine cases of CLM” were reported, 78% pediatric (7/9), with cases occurring mainly after rainfall events and with exposure to puddles/mud. (hasni2024cutaneouslarvamigrans pages 2-6, hasni2024cutaneouslarvamigrans pages 6-7)

Endemic-community prevalence (older but quantitative)

In Manaus, Brazil, CLM prevalence was reported in the QoL study background as up to ~4% overall and 15% in young children in slum communities (contextualizing the burden). (schuster2011lifequalityimpairment pages 1-2)

10. Diagnostics

Clinical diagnosis

Diagnosis is predominantly clinical, based on characteristic serpiginous/migratory track morphology and exposure history; Oman outbreak cases did not require biopsy. (hasni2024cutaneouslarvamigrans pages 2-6)

Laboratory testing

Routine laboratory investigations are often normal; eosinophilia may occur but is not required for diagnosis. (elmi2025cutaneouslarvamigrans pages 1-3, hochedez2007hookwormrelatedcutaneouslarva pages 4-6)

Histopathology / biopsy

Biopsy is not routinely required, but may confirm diagnosis; one 2023 U.S. case described punch biopsy at the leading edge with histology consistent with hookworm. (johanis2023cutaneouslarvamigrans pages 1-3, johanis2023cutaneouslarvamigrans media a6ff90a3)

Differential diagnosis

A recent review of refractory CLM emphasized important mimics and broader differential diagnoses for migratory lesions, including Strongyloides (larva currens—migrates much faster), Gnathostoma, and other parasitic and non-parasitic causes; the differential list included dracunculiasis, fascioliasis, loiasis, paragonimiasis, tungiasis, and myiasis. (currie2025cutaneouslarvamigrans pages 6-7)

A Cureus case report additionally lists common outpatient differentials such as tinea corporis, contact dermatitis, scabies, cellulitis, and arthropod bites. (guarda2026importedcutaneouslarva pages 4-7)

11. Outcome / prognosis

Natural history

CLM is usually self-limited and confined to the skin; however, morbidity can be substantial due to pruritus and sleep disturbance. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, schuster2011lifequalityimpairment pages 1-2)

Treatment outcomes (statistics)

  • Travelers (prospective study): ivermectin achieved an overall 97% cure rate in a prospective series; 77% cured after a single dose and 23% (14/64) required additional treatment because of relapse/non-response; median time to pruritus disappearance 3 days and lesion disappearance 7 days; superinfection occurred in 8% (5 cases). (bouchaud2000cutaneouslarvamigrans pages 4-5)
  • Endemic-community QoL cohort: substantial QoL restoration within weeks after ivermectin (median mDLQI improved to near-normal by 2–4 weeks). (schuster2011lifequalityimpairment pages 1-2, schuster2011lifequalityimpairment pages 3-4)

12. Treatment

First-line pharmacotherapy (real-world implementation)

  • Ivermectin (oral): widely recommended first-line; cohort-series cure rates reported as 94–100% in most series (lowest 81% in one series), with repeat dosing sometimes required. (johanis2023cutaneouslarvamigrans pages 3-5, bouchaud2000cutaneouslarvamigrans pages 4-5)
  • Albendazole (oral): effective alternative; dosing commonly 400 mg/day for 3–7 days, with some practice recommending 400 mg once daily for 5 days (e.g., Oman outbreak recommendation) or 400 mg/day for 1 week in a retrospective series. (johanis2023cutaneouslarvamigrans pages 3-5, hasni2024cutaneouslarvamigrans pages 2-6)

Pediatric considerations

A 2024 case report/review notes a WHO consultation indicating albendazole/mebendazole safety in children ≥12 months and advises against treatment under 12 months; topical therapies may be used when oral therapy is contraindicated. (shrestha2024cutaneouslarvamigrans pages 3-4)

Topical/adjunctive therapy

Topical 10% albendazole is described as an alternative when oral ivermectin/albendazole are contraindicated (e.g., very small children), though multiple lesions/folliculitis may respond less well. (hochedez2007hookwormrelatedcutaneouslarva pages 4-6, shrestha2024cutaneouslarvamigrans pages 3-4)

Treatment developments (2023–2024)

  • Outbreak practice variation (Oman 2024): variability in albendazole prescribing prompted a recommended standardized regimen of albendazole 400 mg once daily for five days and improved surveillance. (hasni2024cutaneouslarvamigrans pages 2-6, hasni2024cutaneouslarvamigrans pages 6-7)
  • Combination therapy and resistance concern: a 2024 two-patient report from Sudan described successful combined albendazole + ivermectin and framed it as potentially relevant amid concerns about emerging antihelminthic resistance. (currie2025cutaneouslarvamigrans pages 13-13)

Suggested MAXO terms (treatments)

  • Anthelmintic therapy; ivermectin administration; albendazole administration; topical anthelmintic therapy; antipruritic therapy (antihistamine); treatment of secondary bacterial infection (antibiotic therapy).

13. Prevention

Primary prevention (behavioral/environmental)

Evidence-based recommendations emphasize: * Consistent footwear and avoidance of direct skin contact with potentially contaminated sand/soil (beaches, sandboxes). (hochedez2007hookwormrelatedcutaneouslarva pages 4-6, shrestha2024cutaneouslarvamigrans pages 1-2) * Pet deworming and management of stray dogs/cats to reduce environmental contamination. (shrestha2024cutaneouslarvamigrans pages 1-2, guarda2026importedcutaneouslarva pages 4-7)

Public health / One Health implementations

The 2024 Oman outbreak report explicitly calls for stronger surveillance and multi-sectoral action, including “electronic notification” of cases, “environmental eradication campaigns,” and collaboration between Ministry of Health, municipality, and agriculture—a practical One Health approach to prevention. (hasni2024cutaneouslarvamigrans pages 6-7)

14. Other species / natural disease

CLM is a zoonosis originating from dogs and cats harboring hookworm infections; environmental contamination with animal feces is repeatedly cited as central to transmission. (rodriguezmorales2021cutaneouslarvamigrans pages 1-3, guarda2026importedcutaneouslarva pages 4-7)

15. Model organisms

No experimental model organism systems were described in the retrieved evidence set. Mechanistic inference relies largely on veterinary parasitology of canine/feline hookworms and human clinical/histopathologic observation. (currie2025cutaneouslarvamigrans pages 6-7, johanis2023cutaneouslarvamigrans media a6ff90a3)

Recent developments and expert synthesis (emphasis 2023–2024)

  1. Climate/environment linkage in applied settings: The Oman 2024 case series/outbreak suggests extreme weather and unusual rainfall may precipitate local clusters through increased muddy exposure and larval survival, highlighting a need for climate-aware surveillance. (hasni2024cutaneouslarvamigrans pages 2-6, hasni2024cutaneouslarvamigrans pages 6-7)
  2. Geographic expansion beyond classic tropics: A 2023 U.S. case acquired in New England illustrates potential northward spread and the importance of clinician vigilance in temperate regions. (johanis2023cutaneouslarvamigrans pages 1-3)
  3. Treatment standardization and access: Recent practice-focused papers emphasize ivermectin as preferred first-line but also document the operational reality of variable dosing practices and the need for standardized regimens and surveillance. (johanis2023cutaneouslarvamigrans pages 3-5, hasni2024cutaneouslarvamigrans pages 6-7)
  4. Emerging resistance concerns (One Health): Clinical reports of refractory disease and calls for combination therapy are framed in the broader context of expanding macrocyclic lactone use in animals and emerging multi-drug resistance in animal hookworms, implying a One Health antimicrobial-resistance problem. (currie2025cutaneouslarvamigrans pages 13-13, currie2025cutaneouslarvamigrans pages 6-7)

Key limitations of this evidence package

  • Many retrieved clinical sources are case reports/series; robust incidence/prevalence estimates for CLM at national/global scale were not present in the retrieved texts.
  • The retrieved full texts did not provide MONDO/MeSH numeric identifiers or CLM-specific ICD codes.
  • Several 2023–2024 items were unobtainable in the current retrieval set; additional targeted PubMed/ontology queries would likely improve identifier completeness.

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