The Creeping Eruption

You come back from a pleasant holiday at the beach and a few days to weeks later you notice a strange itchy red rash on your foot and leg that seems to e traveling under the skin.  You have acquired the creeping eruption or "cutaneous larva migrans".

This skin reaction occurs worldwide although is more common along tropical or subtropical beaches.

It is caused by people either walking or sitting on sand or soil contaminated with hookworms from dogs or cats. These hookworm eggs are in the feces of infected animals that get onto the beach. As larva these nematode worms are able to penetrate the skin of beach patrons. Humans are not the proper hosts so these worms migrate subcutaneously for weeks before dying. The red migratory rash shows where the worm has been so there is no point in digging it out.

In many cases the infection will die out without any treatment although anti-parasite medication can be prescribed for more immediate results.

The history of being in contact with water or sand and the subsequent development of this rash is enough to diagnose this so tests or biopsies are necessary.

Sometimes other parasites may be associated with rashes.  We had one traveler test positive for both schistosomiasis and strongyloides after a trip to Africa.

Schistosomiasis is a severe parasite infection that can invade organs as well as skin. Strongyloides also called threadworms also may infect the body for years.

Our traveller "B" had returned from Africa with exposure to a wide range of conditions that made us more suspicious that she might have more than one infection. If a traveler had acquired one infection from potentially unclean water it might be reasonable to look for other similar organisms.

 

Truthfully many people in the developing world carry parasites and often don't even notice. When I visited the Tamang people of Northern Nepal many people considered it "normal" to have worms in their stool!

We do know that parasites do lead to malnutrition, anemia particularly in those with higher "wormloads"and suggest treating all identified cases.

The best way to prevent the creeping eruption- an annoying but unpleasant rash is to restrict dogs from beaches.  Many developing countries may not do this.  People may likewise bring their dogs at alternative times (night strolls/ early morning walks) when the tourists aren't t around.

If unsure how clean your beach is wear shoes and avoid lying directly on sand.

 

Our patient "B" took a photo of her foot to show her "creeping eruption" and wanted to share this with Sun Readers. She reported that this rash and itch resolved one week after taking anti-parasite medication.

creeping eruption