What's causing this creeping eruption?

And how would you treat it?

A 40-year-old man presents to his GP with a pruritic, erythematous lesion on his foot after returning from a holiday in coastal Brazil a week earlier.

He says the lesion has migrated since he first noticed it.

On examination, a serpiginous, slightly elevated tunnel can be seen on the lateral aspect of his left foot. He is otherwise well, but mentions that the intense pruritus is disturbing his sleep.

Which of the following treatments is the next best step?

  • Surgical excision
  • Doxycycline
  • Ivermectin
  • Symptomatic treatment 

You can check your answer under the image.


Image credit: @forderit.

Answer: Ivermectin

This patient has cutaneous larva migrans, a migratory parasitic infection. It is caused by the larvae of hookworms and is most commonly found in warm, tropical and sub-tropical places, especially where sewage disposal is inadequate. It is common in the Kimberley and other parts of tropical northern Australia. 

A single dose of ivermectin is recommended to relieve pruritus and reduce the risk of systemic infection. A short course of albendazole can be administered as an alternative treatment.

For more images like this go to Figure1.