The Open Dermatology Journal




ISSN: 1874-3722 ― Volume 14, 2020
CASE REPORT

Bullous Cutaneous Larva Migrans And Generalized Cutaneous Larva Migrans: A Rare Clinical Manifestation



Hendra Gunawan1, *, Icha Rachmawati Kusmayadi1, Syawalika Ulya Isneny1
1 Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Abstract

Background:

The skin lesions of Cutaneous Larva Migrans (CLM) commonly manifests as single, linear, irregular, serpiginous raised erythematous track, but the other clinical variants exist. This case series aimed to report one case of a vesiculobullous lesion in CLM and one case of CLM with generalized distribution serpiginous erythematous skin lesion.

Objectives:

We report one case of a vesiculobullous lesion in CLM and one case of CLM with generalized distribution serpiginous erythematous skin lesion.

Conclusion:

There were CLM with vesiculobullous lesions and also with generalized distribution of skin lesion. The pathogenesis of this condition is still unknown. In both cases, albendazole 400 mg per day for 3 and 5 days gave an effective result.

Keywords: Albendazole, Bullous, Cutaneous larva migrans, Generalized, Serpiginous, Vesiculobullous.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 14
First Page: 1
Last Page: 3
Publisher Id: TODJ-14-1
DOI: 10.2174/1874372202014010001

Article History:

Received Date: 26/09/2019
Revision Received Date: 16/12/2019
Acceptance Date: 24/12/2019
Electronic publication date: 14/02/2020
Electronic publication date: 2020

© 2020 Gunawan et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel: +62222032426 ext. 3449, E-mail: endaguna@yahoo.com





1. INTRODUCTION

Cutaneous Larva Migrans or sandworm eruption [1Downing C, Tyring SK. Parasitic diseases Dalam: Griffiths C, Barker JN, Bleiker T, Chalmers R, Creamer D, Eds In: Rook's textbook of dermatology 9th ed. 2016; 33.1-53.] is a creeping eruption caused by nematode larval migration in the epidermis [2Sherman SC, Radford N. Severe infestation of cutaneous larva migrans. J Emerg Med 2004; 26(3): 347-9.
[http://dx.doi.org/10.1016/j.jemermed.2003.11.017] [PMID: 15028337]
]. The most common cause of this disease is Ancylostoma braziliense larvae, commonly found in dogs and cats [1Downing C, Tyring SK. Parasitic diseases Dalam: Griffiths C, Barker JN, Bleiker T, Chalmers R, Creamer D, Eds In: Rook's textbook of dermatology 9th ed. 2016; 33.1-53., 3French SJ, Lindo JF. Severe cutaneous larva migrans in a traveler to Jamaica, West Indies. J Travel Med 2003; 10(4): 249-50.
[http://dx.doi.org/10.2310/7060.2003.40456] [PMID: 12946305]
, 4Lupi O, Downing C, Lee M, Pino L, Bravo F, Giglio P. Mucocutaneous manifestations of helminth infections. J Am Dermatol Elsevier Inc 2015; 73(6): 929.].

Characteristics of early lesions in CLM are erythematous papules on the skin area where the larvae penetrated [3French SJ, Lindo JF. Severe cutaneous larva migrans in a traveler to Jamaica, West Indies. J Travel Med 2003; 10(4): 249-50.
[http://dx.doi.org/10.2310/7060.2003.40456] [PMID: 12946305]
]. These skin lesions occur within one to five days after larval penetration [2Sherman SC, Radford N. Severe infestation of cutaneous larva migrans. J Emerg Med 2004; 26(3): 347-9.
[http://dx.doi.org/10.1016/j.jemermed.2003.11.017] [PMID: 15028337]
, 3French SJ, Lindo JF. Severe cutaneous larva migrans in a traveler to Jamaica, West Indies. J Travel Med 2003; 10(4): 249-50.
[http://dx.doi.org/10.2310/7060.2003.40456] [PMID: 12946305]
]. Furthermore, as the larvae migrate, developing tracks appear as a reddish raised linear line with a serpiginous pattern. Vesiculobullous lesions also can be found in 15% cases of CLM [3French SJ, Lindo JF. Severe cutaneous larva migrans in a traveler to Jamaica, West Indies. J Travel Med 2003; 10(4): 249-50.
[http://dx.doi.org/10.2310/7060.2003.40456] [PMID: 12946305]
]. The skin lesions can be solitary or multiple or general, accompanied by itching. The most commonly affected body parts are the feet, hands, and buttocks [1Downing C, Tyring SK. Parasitic diseases Dalam: Griffiths C, Barker JN, Bleiker T, Chalmers R, Creamer D, Eds In: Rook's textbook of dermatology 9th ed. 2016; 33.1-53.]. There are 2 cases that reported a CLM case with severe clinical manifestations of multiple serpiginous skin eruptions [2Sherman SC, Radford N. Severe infestation of cutaneous larva migrans. J Emerg Med 2004; 26(3): 347-9.
[http://dx.doi.org/10.1016/j.jemermed.2003.11.017] [PMID: 15028337]
, 3French SJ, Lindo JF. Severe cutaneous larva migrans in a traveler to Jamaica, West Indies. J Travel Med 2003; 10(4): 249-50.
[http://dx.doi.org/10.2310/7060.2003.40456] [PMID: 12946305]
]. This CLM case series aimed to report a case with vesiculobullous lesions and a case with a generalized distribution of serpiginous erythematous skin lesions.

2. CASE 1

A 30-year old male came with bullous on the back of the wrist, 4th and 5th fingers of the right hand that feels itchy. He worked as a builder who often comes in contact with the soil and sand without using gloves. On physical examination, there were 7 cm bullous lesions with a serpiginous pattern (Fig. 1). Albendazole 400 mg daily was given for five days with good results.

3. CASE 2

A 20-year old male came with erythematous papules and linear tracks in the entire body except for the face, hands, and feet that feel itchy. He had a history of traveling to the beach and buried his body into the sand. On physical examination, there were erythematous papules, erythematous, and hyperpigmented tracks in the serpiginous pattern, erosions, scales, hemorrhagic crusts, and hyperpigmented macules on the scalp, neck, trunk, buttocks, extremities, as well as the scrotum (Fig. 2). The patient was treated with albendazole 400 mg daily for three days and had a good result.

4. DISCUSSION

Cutaneous Larva Migrans is the most common helminthic infection of human skin and commonly seen in tropical [1Downing C, Tyring SK. Parasitic diseases Dalam: Griffiths C, Barker JN, Bleiker T, Chalmers R, Creamer D, Eds In: Rook's textbook of dermatology 9th ed. 2016; 33.1-53.] or subtropical countries, such as Southeast Asia, South America, and Africa [4Lupi O, Downing C, Lee M, Pino L, Bravo F, Giglio P. Mucocutaneous manifestations of helminth infections. J Am Dermatol Elsevier Inc 2015; 73(6): 929.]. This disease usually affects a person in contact with contaminated soil or sand and tourists [2Sherman SC, Radford N. Severe infestation of cutaneous larva migrans. J Emerg Med 2004; 26(3): 347-9.
[http://dx.doi.org/10.1016/j.jemermed.2003.11.017] [PMID: 15028337]
] during a vacation at the beach [5Kincaid L, Klowak M, Klowak S, Boggild AK. Management of imported cutaneous larva migrans: A case series and mini-review Travel Med Infect Dis 2015; 1-6.].

The diagnosis of CLM can be established based on clinical manifestation [6Bowman DD, Montgomery SP, Zajac AM, Eberhard ML, Kazacos KR. Hookworms of dogs and cats as agents of cutaneous larva migrans. Trends Parasitol 2010; 26(4): 162-7.
[http://dx.doi.org/10.1016/j.pt.2010.01.005] [PMID: 20189454]
-8Gupta M. Bullous cutaneous larva migrans, a case report. J Dermatol Dermatol Surg 2016; 20: 65-6.
[http://dx.doi.org/10.1016/j.jdds.2015.06.003]
] and supported by a history of contact with soil or sand during work or travel [6Bowman DD, Montgomery SP, Zajac AM, Eberhard ML, Kazacos KR. Hookworms of dogs and cats as agents of cutaneous larva migrans. Trends Parasitol 2010; 26(4): 162-7.
[http://dx.doi.org/10.1016/j.pt.2010.01.005] [PMID: 20189454]
, 7Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis 2008; 8(5): 302-9.
[http://dx.doi.org/10.1016/S1473-3099(08)70098-7] [PMID: 18471775]
]. At the penetration site of the larva, erythematous papules will develop after 1-5 days [9James WD, Berger TG, Elston DM, Neuhaus IM. Parasitic infestations, stings, and bites.Andrews’ diseases of the skin 12th ed. 2016; 418-50.]. These skin lesions are accompanied by pruritus and it can be felt before the skin lesions are seen [7Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis 2008; 8(5): 302-9.
[http://dx.doi.org/10.1016/S1473-3099(08)70098-7] [PMID: 18471775]
]. Larva migration along the skin creates a tract that appears as a reddish raised linear line with the serpiginous pattern [4Lupi O, Downing C, Lee M, Pino L, Bravo F, Giglio P. Mucocutaneous manifestations of helminth infections. J Am Dermatol Elsevier Inc 2015; 73(6): 929., 5Kincaid L, Klowak M, Klowak S, Boggild AK. Management of imported cutaneous larva migrans: A case series and mini-review Travel Med Infect Dis 2015; 1-6.]. Tracts are formed between stratum basale and stratum granulosum [7Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis 2008; 8(5): 302-9.
[http://dx.doi.org/10.1016/S1473-3099(08)70098-7] [PMID: 18471775]
, 9James WD, Berger TG, Elston DM, Neuhaus IM. Parasitic infestations, stings, and bites.Andrews’ diseases of the skin 12th ed. 2016; 418-50.]. However, the larva can also persist for several days to several months before starting their migration. Linear lesions are often disconnected by the presence of papules that mark the location of the larvae [9James WD, Berger TG, Elston DM, Neuhaus IM. Parasitic infestations, stings, and bites.Andrews’ diseases of the skin 12th ed. 2016; 418-50., 10Tekely E, Szostakiewicz B, Wawrzycki B, et al. Cutaneous larva migrans syndrome: A case report. Postepy Dermatol Alergol 2013; 30(2): 119-21.
[http://dx.doi.org/10.5114/pdia.2013.34164] [PMID: 24278060]
]. The size of tract varies with lengths of up to 15-20 cm and width of 3 mm [1Downing C, Tyring SK. Parasitic diseases Dalam: Griffiths C, Barker JN, Bleiker T, Chalmers R, Creamer D, Eds In: Rook's textbook of dermatology 9th ed. 2016; 33.1-53., 11Hochedez P, Caumes E. Hookworm-related cutaneous larva migrans. J Travel Med 2007; 14(5): 326-33.
[http://dx.doi.org/10.1111/j.1708-8305.2007.00148.x] [PMID: 17883464]
, 12Comparin C, Rodrigues MM, Santos BC. Extensive cutaneous larva migrans with eczematous reaction on atypical localization. Am J Trop Med Hyg 2016; 94(6): 1185-6.
[http://dx.doi.org/10.4269/ajtmh.15-0581] [PMID: 27252478]
]. The speed of larva migration is between few millimeters to 2 cm per day [2Sherman SC, Radford N. Severe infestation of cutaneous larva migrans. J Emerg Med 2004; 26(3): 347-9.
[http://dx.doi.org/10.1016/j.jemermed.2003.11.017] [PMID: 15028337]
, 6Bowman DD, Montgomery SP, Zajac AM, Eberhard ML, Kazacos KR. Hookworms of dogs and cats as agents of cutaneous larva migrans. Trends Parasitol 2010; 26(4): 162-7.
[http://dx.doi.org/10.1016/j.pt.2010.01.005] [PMID: 20189454]
]. The other CLM skin manifestations are vesicles or bullae [7Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis 2008; 8(5): 302-9.
[http://dx.doi.org/10.1016/S1473-3099(08)70098-7] [PMID: 18471775]
, 10Tekely E, Szostakiewicz B, Wawrzycki B, et al. Cutaneous larva migrans syndrome: A case report. Postepy Dermatol Alergol 2013; 30(2): 119-21.
[http://dx.doi.org/10.5114/pdia.2013.34164] [PMID: 24278060]
]. Vesiculobullous lesion can occur in 15% of CLM cases [1Downing C, Tyring SK. Parasitic diseases Dalam: Griffiths C, Barker JN, Bleiker T, Chalmers R, Creamer D, Eds In: Rook's textbook of dermatology 9th ed. 2016; 33.1-53.] Hochedez et al. [11Hochedez P, Caumes E. Hookworm-related cutaneous larva migrans. J Travel Med 2007; 14(5): 326-33.
[http://dx.doi.org/10.1111/j.1708-8305.2007.00148.x] [PMID: 17883464]
] reported that vesiculobullous lesion could occur in 4-40% of CLM patients.

In general, most CLM patients have only a single larval tract. The skin lesions are commonly found in the lower extremities and buttocks, and only 7% of the CLM lesions manifest in the trunk and upper limb [12Comparin C, Rodrigues MM, Santos BC. Extensive cutaneous larva migrans with eczematous reaction on atypical localization. Am J Trop Med Hyg 2016; 94(6): 1185-6.
[http://dx.doi.org/10.4269/ajtmh.15-0581] [PMID: 27252478]
]. However, the skin lesions may occur in any location, including the face, scalp, and genital [7Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis 2008; 8(5): 302-9.
[http://dx.doi.org/10.1016/S1473-3099(08)70098-7] [PMID: 18471775]
]. Sherman et al. [2Sherman SC, Radford N. Severe infestation of cutaneous larva migrans. J Emerg Med 2004; 26(3): 347-9.
[http://dx.doi.org/10.1016/j.jemermed.2003.11.017] [PMID: 15028337]
] reported a CLM case in a 27-year-old male patient with severe manifestation after a beach trip. From the physical examination, it was found that there were multiple tracts with the serpiginous pattern on the buttocks and right limbs. Another severe CLM case was reported by French et al. [3French SJ, Lindo JF. Severe cutaneous larva migrans in a traveler to Jamaica, West Indies. J Travel Med 2003; 10(4): 249-50.
[http://dx.doi.org/10.2310/7060.2003.40456] [PMID: 12946305]
] on an 18-year-old woman with multiple serpiginous tracts on chest and back. The presence of multiple larvae may cause multiple skin lesions [12Comparin C, Rodrigues MM, Santos BC. Extensive cutaneous larva migrans with eczematous reaction on atypical localization. Am J Trop Med Hyg 2016; 94(6): 1185-6.
[http://dx.doi.org/10.4269/ajtmh.15-0581] [PMID: 27252478]
].

In case 1, the patient worked as a builder who often came in contact with the soil and sand without using gloves. Initially, there were erythematous papules in the hands which then turned into vesicles and bullae accompanied by itching. The patient acknowledged that the lesions increased in length by about 1 cm per day. Based on physical examination, there were bullae in a serpiginous pattern with a length of 7 cm on the back of the wrist, 4th and 5th fingers of the right hand that feels itchy. In case 2, the patient with a history of traveling to the beach buried his body in the sand came with erythematous papules and linear tracks on the entire body except for the face, hands, and feet that feel itchy. Five days before the lesions appeared, he went to the beach and buried his body in the sand. During that time, he also denied eating raw fish. On physical examination, there were skin lesions with generalized distribution at scalp, neck, chest, abdomen, back, buttocks, arms, legs, and scrotum in the form of erythematous and hyperpigmented tracks, erosions, scales, hemorrhagic crust, and hyperpigmented macules.

Factors that cause vesiculobullous lesions and multiple lesions in CLM are still unknown. Shimogawara et al. [13Shimogawara R, Hata N, Schuster A, et al. Hookworm-related cutaneous larva migrans in patients living in an endemic community in Brazil: Immunological patterns before and after ivermectin treatmen. Eur J Microbiol Immunol (Bp) 2013; 3(4): 258-66.
[http://dx.doi.org/10.1556/EuJMI.3.2013.4.4] [PMID: 24294495]
] showed that there were increased levels of several cytokines, such as interleukin (IL)-4, IL-5, IL-6, and IL-10 in the peripheral circulation of CLM patients. The activation of the T helper-2 (Th2) cell leads to an increase in IL-5 level that causes eosinophil withdrawal [1Downing C, Tyring SK. Parasitic diseases Dalam: Griffiths C, Barker JN, Bleiker T, Chalmers R, Creamer D, Eds In: Rook's textbook of dermatology 9th ed. 2016; 33.1-53.] from the bone marrow to the peripheral circulation. Furthermore, IL-4 and other cytokines attract the eosinophils from the peripheral circulation to the epidermis to eliminate the larva [14Jackson A, Heukelbach J, Calheiros CM, Soares VdeL, Harms G, Feldmeier H. A study in a community in Brazil in which cutaneous larva migrans is endemic. Clin Infect Dis 2006; 43(2): e13-8.
[http://dx.doi.org/10.1086/505221] [PMID: 16779735]
].

In cases of CLM with severe symptoms, the patient can be given various treatments, either topical, systemic, or cryosurgery treatment [7Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis 2008; 8(5): 302-9.
[http://dx.doi.org/10.1016/S1473-3099(08)70098-7] [PMID: 18471775]
]. Systemic treatment is the first-line treatment of CLM [15Szczecinska W, Abdullah A. Cutaneous larva migrans Dalam: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, Eds Treatment of skin disease 4th ed. 2014; 160-., 16Veraldi S, Bottini S, Rizzitelli G, Persico MC, Irccs F, Granda C. One-week therapy with oral albendazole in hookworm-related cutaneous larva migrans: A retrospective study on 78 patients. J Dermatolog Treat 2012; 23(3): 189-91.
[http://dx.doi.org/10.3109/09546634.2010.544707] [PMID: 21294643]
]. Recommended treatment is the administration of systemic antihelmintic drugs, such as albendazole, ivermectin [1Downing C, Tyring SK. Parasitic diseases Dalam: Griffiths C, Barker JN, Bleiker T, Chalmers R, Creamer D, Eds In: Rook's textbook of dermatology 9th ed. 2016; 33.1-53., 2Sherman SC, Radford N. Severe infestation of cutaneous larva migrans. J Emerg Med 2004; 26(3): 347-9.
[http://dx.doi.org/10.1016/j.jemermed.2003.11.017] [PMID: 15028337]
], or thiabendazole [4Lupi O, Downing C, Lee M, Pino L, Bravo F, Giglio P. Mucocutaneous manifestations of helminth infections. J Am Dermatol Elsevier Inc 2015; 73(6): 929.]. Kincaid et al. [5Kincaid L, Klowak M, Klowak S, Boggild AK. Management of imported cutaneous larva migrans: A case series and mini-review Travel Med Infect Dis 2015; 1-6.] reported that over 90% of CLM cases with albendazole 400 mg per day for three days showed a good response. Albendazole can also be given up to seven days, especially in multiple skin lesions [17Albanese G, Venturi C, Galbiati G. Treatment of larva migrans cutanea (creeping eruption): A comparison between albendazole and traditional therapy. Int J Dermatol 2001; 40(1): 67-71.
[http://dx.doi.org/10.1046/j.1365-4362.2001.01103.x] [PMID: 11277961]
, 18Sunderkötter C, Von E, Schöfer H, Mempel M, Reinel D, Wolf G. Guideline diagnosis and therapy of cutaneous larva migrans (creeping disease) 2014; 86-91.]. Caumes et al. [19Caumes E, Carriere J, Datry A, Gaxotte P, Danis M, Gentilini M. A randomized trial of ivermectin versus albendazole for the treatment of cutaneous larva migrans. Am J Trop Med Hyg 1993; 49(5): 641-4.
[http://dx.doi.org/10.4269/ajtmh.1993.49.641] [PMID: 8250105]
] suggested higher effectiveness of single-dose ivermectin compared to single-dose albendazole in CLM treatment. However, CLM with severe clinical manifestations, the administration of albendazole for three days gave a good result [12Comparin C, Rodrigues MM, Santos BC. Extensive cutaneous larva migrans with eczematous reaction on atypical localization. Am J Trop Med Hyg 2016; 94(6): 1185-6.
[http://dx.doi.org/10.4269/ajtmh.15-0581] [PMID: 27252478]
, 16Veraldi S, Bottini S, Rizzitelli G, Persico MC, Irccs F, Granda C. One-week therapy with oral albendazole in hookworm-related cutaneous larva migrans: A retrospective study on 78 patients. J Dermatolog Treat 2012; 23(3): 189-91.
[http://dx.doi.org/10.3109/09546634.2010.544707] [PMID: 21294643]
].

In this case series, both patients were treated with albendazole 400 mg per day for three to five days. In case 1, albendazole 400 mg per day was given for five days. On the 5th day of treatment, there were no new skin lesions. In case 2, albendazole 400 mg per day was given for three days. On the 4th day of observation, itching was reduced, and there were no new skin lesions.

The skin lesions of CLM can disappear within 2-8 weeks [1Downing C, Tyring SK. Parasitic diseases Dalam: Griffiths C, Barker JN, Bleiker T, Chalmers R, Creamer D, Eds In: Rook's textbook of dermatology 9th ed. 2016; 33.1-53., 17Albanese G, Venturi C, Galbiati G. Treatment of larva migrans cutanea (creeping eruption): A comparison between albendazole and traditional therapy. Int J Dermatol 2001; 40(1): 67-71.
[http://dx.doi.org/10.1046/j.1365-4362.2001.01103.x] [PMID: 11277961]
]. Both cases have improved skin lesions. Relapse in CLM can occur after 11 days of treatment with single-dose albendazole 400 mg, 16 whereas albendazole 400 mg per day for three days has efficacy of 100% [5Kincaid L, Klowak M, Klowak S, Boggild AK. Management of imported cutaneous larva migrans: A case series and mini-review Travel Med Infect Dis 2015; 1-6.]. In both cases, albendazole 400 mg per day was given for five and three days, respectively, without relapse.

Fig. (1)
Bullous lesions with linear and irregular in the serpiginous pattern.


Fig. (2)
Erythematous papules, erythematous and hyperpigmented tracks in the serpiginous pattern, erosions, scales, hemorrhagic crusts, hyperpigmented macules on the scalp, neck, trunk, buttocks, and extremities.


CONCLUSION

CLM usually manifests as an erythematous, linear, irregular, serpiginous pattern tract, but other clinical variants can be found. There were CLM with vesiculobullous lesions and also with generalized distribution of skin lesion. That condition is supposed to be related to the immune response. In both cases, albendazole 400 mg per day for 3 and 5 days gave an effective result.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

This study was approved by the Health Research Ethics Committee of Dr Hasan Sadikin Hospital Bandung, Indonesia under approval number LB.02.01/X.6.5/277/2019.

HUMAN AND ANIMAL RIGHTS

Not applicable.

CONSENT FOR PUBLICATION

Each participant signed an informed consent to participate in the study.

STANDARD OF REPORTING

CARE guidelines and methodology were followed to conduct the study.

FUNDING

None.

CONFLICT OF INTEREST

The author declares no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

[1] Downing C, Tyring SK. Parasitic diseases Dalam: Griffiths C, Barker JN, Bleiker T, Chalmers R, Creamer D, Eds In: Rook's textbook of dermatology 9th ed. 2016; 33.1-53.
[2] Sherman SC, Radford N. Severe infestation of cutaneous larva migrans. J Emerg Med 2004; 26(3): 347-9.
[http://dx.doi.org/10.1016/j.jemermed.2003.11.017] [PMID: 15028337]
[3] French SJ, Lindo JF. Severe cutaneous larva migrans in a traveler to Jamaica, West Indies. J Travel Med 2003; 10(4): 249-50.
[http://dx.doi.org/10.2310/7060.2003.40456] [PMID: 12946305]
[4] Lupi O, Downing C, Lee M, Pino L, Bravo F, Giglio P. Mucocutaneous manifestations of helminth infections. J Am Dermatol Elsevier Inc 2015; 73(6): 929.
[5] Kincaid L, Klowak M, Klowak S, Boggild AK. Management of imported cutaneous larva migrans: A case series and mini-review Travel Med Infect Dis 2015; 1-6.
[6] Bowman DD, Montgomery SP, Zajac AM, Eberhard ML, Kazacos KR. Hookworms of dogs and cats as agents of cutaneous larva migrans. Trends Parasitol 2010; 26(4): 162-7.
[http://dx.doi.org/10.1016/j.pt.2010.01.005] [PMID: 20189454]
[7] Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis 2008; 8(5): 302-9.
[http://dx.doi.org/10.1016/S1473-3099(08)70098-7] [PMID: 18471775]
[8] Gupta M. Bullous cutaneous larva migrans, a case report. J Dermatol Dermatol Surg 2016; 20: 65-6.
[http://dx.doi.org/10.1016/j.jdds.2015.06.003]
[9] James WD, Berger TG, Elston DM, Neuhaus IM. Parasitic infestations, stings, and bites.Andrews’ diseases of the skin 12th ed. 2016; 418-50.
[10] Tekely E, Szostakiewicz B, Wawrzycki B, et al. Cutaneous larva migrans syndrome: A case report. Postepy Dermatol Alergol 2013; 30(2): 119-21.
[http://dx.doi.org/10.5114/pdia.2013.34164] [PMID: 24278060]
[11] Hochedez P, Caumes E. Hookworm-related cutaneous larva migrans. J Travel Med 2007; 14(5): 326-33.
[http://dx.doi.org/10.1111/j.1708-8305.2007.00148.x] [PMID: 17883464]
[12] Comparin C, Rodrigues MM, Santos BC. Extensive cutaneous larva migrans with eczematous reaction on atypical localization. Am J Trop Med Hyg 2016; 94(6): 1185-6.
[http://dx.doi.org/10.4269/ajtmh.15-0581] [PMID: 27252478]
[13] Shimogawara R, Hata N, Schuster A, et al. Hookworm-related cutaneous larva migrans in patients living in an endemic community in Brazil: Immunological patterns before and after ivermectin treatmen. Eur J Microbiol Immunol (Bp) 2013; 3(4): 258-66.
[http://dx.doi.org/10.1556/EuJMI.3.2013.4.4] [PMID: 24294495]
[14] Jackson A, Heukelbach J, Calheiros CM, Soares VdeL, Harms G, Feldmeier H. A study in a community in Brazil in which cutaneous larva migrans is endemic. Clin Infect Dis 2006; 43(2): e13-8.
[http://dx.doi.org/10.1086/505221] [PMID: 16779735]
[15] Szczecinska W, Abdullah A. Cutaneous larva migrans Dalam: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, Eds Treatment of skin disease 4th ed. 2014; 160-.
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(Indiana University School of Nursing, USA)

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Jacques Descotes
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"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


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Richard Reithinger
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J. Ferwerda
(University of Oxford, UK)

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Sean L. Kitson
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Philippe Hernigou
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Peter Chiba
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"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
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Kenji Hashimoto
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(National Central University, Taiwan)


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