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Cutaneous larva migrans (CLM) is a distinctive cutaneous eruption caused by the invasion and migration of larva of parasites in skin.1 It is also known by various other names, such as creeping eruption, sand worm, plumber’s itch, duck hunter’s itch, and epidermatitis linearis migrans.2 CLM occurs commonly in exposed areas, such as feet, buttocks, and hand.1 Isolated occurrence of CLM on the penis is very rare and, hence, rarely reported.
A 24 year old unmarried male agricultural labourer presented with itchy lesions on the penis of 5 days’ duration. The lesion started on the tip of the prepuce and gradually progressed upwards in a serpentine fashion. He had no lesions elsewhere on the body. He denied a history of premarital sexual contact but had visited a beach resort. He had not applied any topical medication on his penis.
On physical examination, the patient was uncircumcised. A linear serpentine lesion was seen extending from the tip of the prepuce to the shaft on the ventral aspect of the penis (fig 1). He had no other skin lesions.
His routine haemogram and serum biochemistry were within normal limits. Stool examination did not reveal any parasites. A clinical diagnosis of cutaneous larva migrans was made and he was put on oral albendazole 400 mg twice daily for 3 days. The lesion stopped progressing after 2 days of treatment. The lesion completely subsided by 7 days and there was no recurrence at follow up after 4 weeks.
Cutaneous larva migrans is a self limiting dermatitis commonly known as “creeping eruption,”2 because of its distinctive feature that the lesion creeps or migrates caused by the presence of a moving parasite in the skin. CLM has a worldwide distribution though it is common in the tropics and subtropics.2 The occurrence of CLM is influenced by poor sanitation and appropriate environmental conditions.3
The clinical features of CLM may vary from non-specific dermatitis to typical creeping eruption. The initial lesion starts as an erythematous itchy papule. Soon, a slightly raised flesh coloured swollen lesion about 2–3 mm thick develops and forms linear, serpentine (serpiginous), or bizarre tracts. The larva migrates about 2–5 cm per day and forms the tortuous tracts.4 Sometimes, multiple vesicles may appear along the tract. Rarely, hundreds of tracts may be seen in a severely infected person.5
Cutaneous larva migrans can be grouped into several types depending upon the species responsible for the lesions and their clinical appearance.6 They are type 1 (caused by animal hookworms), type 2 (human hookworms), type 3 (human strongyloides), type 4 (animal strongyloides), type 5 (Gnathostoma), and type 6 (insect larva).6 CLM is usually caused by third stage larva (filariform larva) of dog and cat hookworms (Ancylostomacaninum and Ancylostomabrasiliensis, respectively) and rarely by Uncinariastenochepala, Bunostomumphlebotomun, or the human larvae of Necatoramericanus and Ancylostomaduodenale.4,5
Cutaneous larva migrans is usually self limiting but the symptoms (itching) and possible complications warrant treatment.1 Various physical treatments, such as surgery and cryotherapy, have been tried with little success. The topical treatments that have been used include 15% thiabendazole, 2% Gammexane cream, 25% piperazine citrate, and metriphonate.7 Though many types of treatment have been used, albendazole is considered to be the drug of choice.8 Albendazole is used in the dosage of 400–800 mg/day for a period that may vary from 1–7 days.9 Eradication of larva causing CLM is impractical, but avoiding contact with contaminated soil of beaches can prevent it.1,2
In our patient the localisation of CLM was unique and this could possibly be attributed to the habit of not wearing underwear when playing on the beach, thus predisposing him to develop lesions on genitalia.
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