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.
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