The typical tortuous skin lesions of hookworm disease are aptly named skin mole. Fortunately, this exceedingly unpleasant disease has a good chance of cure and can be easily avoided with a little caution.
What is hookworm disease?
Hookworm disease is caused by several genera of hookworm larvae. The most common causative agents are thought to be Necator americanus, Ancylostoma duodenale, both found only in humans, and Ancylostoma brasiliense, the dog hookworm. Other names for the disease include skin mole, creeping eruption, pit disease, ankylostomiasis, and larva migrans. It is one of the most common diseases of the skin in tropical and warm areas. Hookworms live in Asia, Africa, the Caribbean, and Central and South America. The worms can also occur in the Mediterranean region when it is very hot. The disease was first mentioned in writing in 1874, and in 1928 it was assigned to specific pathogens. Skin mole is particularly common among mine and tunnel workers, which is why it is considered an occupational disease among them.
Causes
When larvae of hookworms bore into a person’s skin, hookworm disease develops. Infection usually occurs when a person walks barefoot over ground contaminated with hookworm-infested animal and human feces, such as at a swimming beach. Infected animals and humans excrete hookworm eggs with their feces, which develop into larvae within a few days. These can survive for two to three weeks without a host. The disease can also be triggered by food contaminated with hookworms. However, this case is rather rare. Human-to-human transmission can be ruled out. Skin mole is the name given to changes in the skin that form when the larvae crawl under the skin.
Symptoms, complaints, and signs
Just a few hours after the larvae penetrate the skin, hookworm disease and skin mole may become noticeable with redness and itching. If the hookworm larvae migrate into the lungs or larynx, affected individuals experience coughing or nausea, hoarseness and shortness of breath. Colonization of the digestive tract becomes noticeable about one to four weeks after infection by nausea, vomiting, abdominal pain, loss of appetite and flatulence, usually accompanied by bloody-mucous diarrhea. A severe infestation can also result in anemia, which is characterized by general weakness, loss of performance, difficulty concentrating, headaches and conspicuous pallor of the skin. Other symptoms may include hair loss and brittle nails. In general, hookworm disease weakens the body’s defense system and makes it more susceptible to infections; due to the protein loss associated with the disease, increased water is often deposited in the tissues (edema formation). The skin mole caused by the larvae of dog and cat hookworms remains just under the skin without penetrating deeper organs. In the early stages, the parasites cause fairly nonspecific skin lesions such as redness and swelling. Once the larvae begin their migration, their ducts become visible in the form of red, sinuous lines that can lengthen by about three centimeters per day. The accompanying itching is described as very severe to almost unbearable.
Diagnosis and course
The diagnosis is usually made quickly because of the typical skin lesions. They are tortuous, reddish, thin ducts that form under the skin. Fecal examination can also detect hookworm eggs under the microscope. Initially, severe itching occurs at the sites of skin lesions, especially at the larvae entry site. After the larvae have burrowed under the skin, they enter the lungs and intestines through the bloodstream. Pathogens in the lungs trigger strong coughing stimuli. In the intestine, the larvae begin to develop into adult worms. This takes about a month. The larvae attach to the mucosa of the small intestine and suck blood, causing severe blood loss and possibly even anemia. One to four weeks after infection, further symptoms appear, such as nausea and vomiting, abdominal pain, flatulence, mucous-bloody diarrhea, loss of appetite and, in particularly severe cases, signs of bronchitis.Although the larvae of the dog hookworm cause severely itchy skin irritations, they disappear after a few weeks because they cannot survive in the skin of humans.
Complications
In most cases, these diseases cause very unpleasant discomfort on the skin, which can severely limit the patient’s life and reduce the quality of life. In most cases, itching and redness develop on the skin. These can negatively affect the patient’s aesthetics, leading to decreased self-esteem or inferiority complexes. Furthermore, anemia occurs, which has a very negative effect on the patient’s health. Those affected suffer from severe abdominal pain and vomiting and nausea. Not infrequently, diarrhea and flatulence also occur, with bloody stools not infrequently triggering panic attacks. Patients also suffer from a loss of appetite and may show signs of deficiency. If the pathogens also spread to the lungs, a severe cough and inflammation of the respiratory tract may occur. As a rule, these diseases can be treated relatively easily, so that there are no further complications and discomfort. Medications are mainly used for this purpose. Life expectancy is not reduced if treatment is successful.
When should you go to the doctor?
If swelling, ulceration, or elevation of the skin is noticed, a skin mole may be present. A visit to the doctor is advisable if symptoms persist longer than usual or if other symptoms appear. If symptoms such as itching, discoloration of the skin or open wounds occur, medical advice is required. At the latest, if inflammations occur, the affected person should go to the family doctor. He can diagnose the hookworm disease and initiate further measures. Concomitant symptoms such as diarrhea, nausea and vomiting require medical attention if they persist over a period of several days or weeks. Serious complications such as persistent abdominal cramps, severe flatulence or high fever should be clarified immediately. The same applies to lesions under the feet, blood accumulation in the stool or functional disorders of the limbs. If the above-mentioned complaints occur after contact with a possibly infected animal or after visiting a bathing beach, the suspicion of a skin mole is obvious. In this case, it is best to talk to the family doctor.
Treatment and therapy
Hookworm disease can be treated well with anthelmintics. Ivermectin, albendazole, and thiabendazole have been shown to be effective agents. They are applied topically or taken orally, depending on where the larvae are located. Oral intake is done only when there is no improvement after a week of external treatment, as it is associated with many side effects. The anthelmintics paralyze the muscles of the larvae, making it easier for the body’s immune system to fight and eliminate them. Severe accompanying symptoms such as diarrhea and vomiting can also be relieved with appropriate medications. Cooling and soothing creams and ointments weaken the itching. Surgical measures or icing have been shown to have little effect.
Outlook and prognosis
The prognosis for hookworm disease and skin mole is favorable. Most patients experience spontaneous healing after a few days or weeks. The symptoms heal completely. Consequential symptoms or impairments are not normally to be expected. More than 80% of the pathogens die on their own if the patient’s immune system is intact and are subsequently transported out of the organism. Frequently, treatment consists of symptomatic care of the affected person, since the pathogens have already been rendered inactive by the body’s own defense system and no longer pose a threat. In the case of hookworm disease, serious and life-threatening complications can occur during the course of the disease in some risk groups. Children, in particular, require adequate medical care if blood loss is high. They are at increased risk of mortality if they do not receive treatment. In addition, there is a risk of developing further infections, which must be minimized. If further illnesses occur, the otherwise good prognosis deteriorates considerably.Hookworm disease and skin mole demand a lot of resources from the organism, so that if the infection continues, the patient experiences a significant deterioration of the general state of health. In severe cases, the internal forces are not sufficient and permanent impairment or shortening of the existing life expectancy occurs.
Prevention
Currently, there is no vaccination against hookworms, but it is in the development phase. However, there are some measures to prevent hookworm disease: those who are in a tropical or hot region should not walk barefoot but wear sturdy shoes. Underpads and loungers on bathing beaches could be contaminated by animal or human feces and should be avoided. Other dangerous places are playgrounds and sandpits, as they could be contaminated with animal droppings. They should therefore be cleaned regularly. Regular and careful deworming and delousing of pets is also part of the preventive measures. Those who are already infected should only use toilet facilities and not defecate in the open.
Aftercare
Usually, no follow-up is needed when treating intestinal hookworms. They respond well to drug therapy and die quickly. However, it is different with hookworms that have not taken the usual route to the intestine but have lodged in skeletal muscle. The active substance often reaches these inadequately, they survive and continue their journey to the intestine. Once there, they cause typical symptoms such as fatigue, loss of appetite, abdominal pain, flatulence, or even mucous-bloody diarrhea. Affected individuals should take the occurrence of such symptoms seriously and contact their physician regarding renewed therapy. During or after therapy, a diet-based parasite cure can be implemented. Avoiding sugar and carbohydrates will literally starve parasites and intestinal fungi. Likewise, following treatment, an intestinal cleanse can be performed with subsequent intestinal sanitation. By means of a stool sample, the composition of the intestinal bacteria is determined in the laboratory and the intestinal flora is built up by targeted ingestion of certain bacteria. In the case of an infestation with skin moles, more precisely the larvae of the hookworm, severe side effects may occur in the course of treatment. Affected individuals can relieve the itching of the larval ducts located under the skin using antihistamines and must contact a doctor immediately if they experience symptoms such as diarrhea, vomiting or malaise.
What you can do yourself
Patients with hookworm disease and skin mole follow the instructions they receive from their doctor. Sufferers counter the various symptoms of the disease with adapted measures, although prior consultation with the medical support staff is appropriate. Initially, those affected try to resist the unpleasant itching. To help with this, patients avoid sweaty activities as well as irritating cosmetic products. If possible, individuals limit the use of cosmetics on the skin during treatment. In addition, since those affected often suffer from nausea and vomiting, a diet tailored to the symptoms is followed. At best, the diet is easily digestible and without foods that irritate the stomach. In the case of gastrointestinal symptoms, patients allow themselves physical rest and pay increased attention to the hygiene of the food consumed. In some cases, affected patients suffer from coughing difficulties, and it is helpful to stop or at least reduce smoking while the disease is being treated. Infection with other respiratory diseases should be avoided. The affected persons take the medications prescribed for the treatment of hookworm disease and skin mole, following the doctor’s instructions regarding time and dosage.
