Symptoms
The disease is commonly seen on the lower extremities and buttocks and manifests as intensely itchy, reddened, straight or curved ducts in the skin that grow regularly in one direction. The infestation may persist for weeks to months without treatment, and older ducts become crusted over time. Complications include secondary infections and skin afflictions. Migratory larvae are most commonly seen in our latitudes in travelers returning from the Caribbean, Maldives, Southeast Asia, and Africa who have picked them up on a contaminated beach.
Causes
The cause of the disease is an infestation with larvae of various worms, mainly hookworms and , which usually infest dogs and cats and live in the intestines of these animals. The larvae migrate in the skin by enzymatically dissolving the tissue. Humans represent a false host, i.e. the worms cannot reproduce further in them and eventually die. The disease is transmitted by dog and cat feces. From there, the larvae enter the skin through direct contact, for example when sitting or walking barefoot on the beach. The “migration” can then begin immediately or even after months.
Diagnosis
The diagnosis is usually based on the typical clinical picture and the patient’s history (stay in a risk area). Other skin diseases may be considered as differential diagnoses.
Treatment
The disease does heal on its own within weeks to months. However, because of the potential complications, the literature recommends therapy with a vermifuge (anthelmintic) that significantly reduces the duration of infestation. Systemic ivermectin or albendazole are frequently mentioned. Thiabendazole ointment (10%-15% in a hydrophilic base) applied 2-3 times daily for 5-10 days is a possible alternative. However, thiabendazole is not commercially available as a drug in many countries and would have to be prepared as an extemporaneous formulation in a pharmacy (problem: obtaining the raw material).
Prevention
- Wear bathing shoes on the beach.
- Keep dogs and cats off the beach (difficult).
- Do not lie down directly on the dry sand, but for example on a mattress or a lounger.
