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Creeping eruption

Parasite infection - hookworm; Cutaneous larvae migrans; Zoonotic hookworm; Ancylostoma caninum; Ancylostoma braziliensis; Bunostomum phlebotomum; Uncinaria stenocephala

Creeping eruption is a human infection with dog or cat hookworm larvae (immature worms).

Causes

Hookworm eggs are found in the stool of infected dogs and cats. When the eggs hatch, the larvae can infest soil and vegetation.

When you come into contact with this infested soil, the larvae can burrow into your skin. They cause an intense inflammatory response that leads to a rash and severe itching.

Creeping eruption is more common in countries with warm climates. In the United States, the Southeast has the highest rates of infection. The main risk factor for this disease is contact with damp, sandy soil that has been contaminated with infected cat or dog stool. More children than adults are infected.

Symptoms

Symptoms of creeping eruption include:

  • Blisters
  • Itching, may be more severe at night
  • Raised, snakelike tracks in the skin that may spread over time, usually about 1 cm (less than one half inch) per day, usually on the feet and legs (severe infections may cause several tracks).

Exams and Tests

Your health care provider can often diagnose this condition by looking at your skin. In rare cases, a skin biopsy is done to rule out other conditions. In very rare cases, a blood test is done to see if you have increased eosinophils (a type of white blood cell).

Treatment

Anti-parasitic medicines may be used to treat the infection.

Outlook (Prognosis)

Creeping eruption often goes away by itself over weeks to months. Treatment helps the infection go away more quickly.

Possible Complications

Creeping eruption may lead to these complications:

  • Bacterial skin infections caused by scratching
  • Spread of the infection through the bloodstream to the lungs or small intestine (rare)

When to Contact a Medical Professional

Make an appointment with your provider if you or your child have skin sores that are:

  • Snake-like
  • Itchy
  • Moving from one area to another.

Prevention

Public sanitation and deworming of dogs and cats have decreased hookworm infestation in the United States.

Hookworm larvae often enter the body through bare feet, so wearing shoes in areas where hookworm infestations are known to occur helps prevent infection.

References

Habif TP. Infestations and bites. In: Habif TP, ed. Clinical Dermatology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 15.

Nash TE. Visceral larva migrans and other uncommon helminth infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 292.

    • Hookworm - mouth of the organism

      Hookworm - mouth of the organism - illustration

      Necator americanus

      Hookworm - mouth of the organism

      illustration

    • Hookworm - close-up of the organism

      Hookworm - close-up of the organism - illustration

      Ancyclostoma duodenale

      Hookworm - close-up of the organism

      illustration

    • Hookworm - Ancyclostoma caninum

      Hookworm - Ancyclostoma caninum - illustration

      This is a photograph of a hookworm on the lining of the intestine. (Image courtesy of the Centers for Disease Control and Prevention.)

      Hookworm - Ancyclostoma caninum

      illustration

    • Cutaneous larva migrans

      Cutaneous larva migrans - illustration

      Cutaneous larva migrans is a condition that occurs when dog or cat hookworm larvae migrate through the skin. The migration produces a raised, red, twisting (serpiginous) pattern on the skin.

      Cutaneous larva migrans

      illustration

    • Strongyloidiasis, creeping eruption on the back

      Strongyloidiasis, creeping eruption on the back - illustration

      Hookworm larvae that have migrated through the skin have caused the reddish serpiginous (snake-like) pattern on the left side of this individual's back.

      Strongyloidiasis, creeping eruption on the back

      illustration

      • Hookworm - mouth of the organism

        Hookworm - mouth of the organism - illustration

        Necator americanus

        Hookworm - mouth of the organism

        illustration

      • Hookworm - close-up of the organism

        Hookworm - close-up of the organism - illustration

        Ancyclostoma duodenale

        Hookworm - close-up of the organism

        illustration

      • Hookworm - Ancyclostoma caninum

        Hookworm - Ancyclostoma caninum - illustration

        This is a photograph of a hookworm on the lining of the intestine. (Image courtesy of the Centers for Disease Control and Prevention.)

        Hookworm - Ancyclostoma caninum

        illustration

      • Cutaneous larva migrans

        Cutaneous larva migrans - illustration

        Cutaneous larva migrans is a condition that occurs when dog or cat hookworm larvae migrate through the skin. The migration produces a raised, red, twisting (serpiginous) pattern on the skin.

        Cutaneous larva migrans

        illustration

      • Strongyloidiasis, creeping eruption on the back

        Strongyloidiasis, creeping eruption on the back - illustration

        Hookworm larvae that have migrated through the skin have caused the reddish serpiginous (snake-like) pattern on the left side of this individual's back.

        Strongyloidiasis, creeping eruption on the back

        illustration

      Review Date: 11/14/2016

      Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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