Sir,Cutaneous larva migrans are lesions that migrate or creep on the skin and are due to the presence of moving parasites in the skin. It is also known as creeping eruption, sandworm eruptions, plumber's itch, and duck hunter's itch. Causative larvae are from Ancylostoma braziliense, Ancylostoma caninum, Ancylostoma ceylonicum, Uncinaria stenocephala, and Bunostomum phlebotomum.[1] In humans, the most common cause is the dog hookworm and A. braziliense. Sandpits, seashore, or areas with loose, wet soil are places where humans acquire the infection. Humans are dead-end hosts. People who come into contact with such soil – such as gardeners, hunters, children who play in sandpits, and people who frequently visit the beaches are the ones affected. Once the larvae gain entry into the skin, itchy, skin-colored tortuous, linear thread-like lesions start with an advancing end, which moves at a rate of about 2 mm–3 cm/day. Usual sites of infection are the hands, feet, buttocks, and back. Sugathan[2] in 2002 reported a case of massive infestation of cutaneous larva migrans affecting the whole body. Here, we report a case of creeping eruption at an unusual and yet unreported site.A young adult, uncircumcised fisherman, reported to us with severe itching of the genitalia, which started 3 weeks ago. He consulted a doctor and was given antiscabetic treatment with no relief of symptoms. He gave a history of carrying sand from the seashore for building his own residence, wearing only boxer shorts. There was no family history of itching. He was nondiabetic, not on any medication, and gave no history of extramarital contact.On examination, he was an healthy adult, the only finding being a raised, grayish white, tortuous skin lesion starting from the coronal sulcus with an active end moving over the glans penis [Figure 1]. The clinical picture was typical of larva migrans. He was treated with albendazole 400 mg once a day for 3 days with complete relief of symptoms.
Figure 1
Tortuous skin lesion starting from the coronal sulcus with an active end moving over the glans penis
Tortuous skin lesion starting from the coronal sulcus with an active end moving over the glans penisFor the nematodes of other animals, humans are a dead-end host. Warm wet soil contaminated with the feces of infected animals can transmit the disease. The eggs hatch into larvae which gain entry into the human skin through minor abrasions or even intact skin through the hair follicles. Two to three days after entry, it starts to migrate in the skin at a speed of 1–2 cm/day. Severe itching ensues, which often result in secondary infection. Most often, we see cases that are eczematized, which makes the diagnosis difficult. A high index of suspicion is a must if this is to be diagnosed after secondary infection.Our case was initially mistaken for scabies because of the location of the lesion. On closer examination, we were able to detect the tortuous lesion with an advancing end which helped us arrive at the correct diagnosis.Literature review showed cases of larva migrans occurring on the shaft of the penis[3] as well as on the prepuce,[4] but never on the glans penis.
Figure 1