Cutaneous larvae migrans (also called "creeping eruption" or "ground itch") is found in southeastern and Gulf states, and in tropical developing countries.
Cutaneous larva migrans (CLM) is a cutaneous lesion produced by percutaneous penetration and migration of larvae of various nematode parasites, characterized by erythematous, serpiginous, papular, or vesicular linear lesions corresponding to the movements of the larvae beneath the skin.
Humans are aberrant, dead-end hosts who acquire the parasite from environment contaminated with animal feces. Larvae remain viable in soil/sand for several weeks. Third-stage larvae penetrate human skin and migrate up to several centimeters a day, usually between stratum germinativum and stratum corneum. Parasite induces localized eosinophilic inflammatory reaction. Most larvae are unable to develop further or invade deeper tissues and die after days or months.
The larvae can then either lie dormant for weeks or months or immediately begin creeping activity that create 2-3mm wide, snakelike tracks stretching 3-4cm from the penetration site. These are slightly raised, flesh-coloured or pink and cause intense itching. Tracks advance a few millimetres to a few centimetres daily and if many larvae are involved a disorganised series of loops and tortuous tracks may form.
Sites most commonly affected are the feet, spaces between the toes, hands, knees and buttocks.
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