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Clinical Images  |   August 2016
Rash in a Returning Traveler
Author Notes
  • From the Department of Family and Community Medicine at Drexel University College of Medicine in Philadelphia, Pennsylvania. Dr Schieber is a third-year resident. 
  •  *Address correspondence to Alexandra Schieber, DO, Family and Community Medicine, Drexel University College of Medicine, 10 Shurs Ln, Suite 203, Philadelphia, PA 19127-2123. E-mail: alexandra.schieber@gmail.com
     
Article Information
Imaging / Clinical Images
Clinical Images   |   August 2016
Rash in a Returning Traveler
The Journal of the American Osteopathic Association, August 2016, Vol. 116, 553. doi:10.7556/jaoa.2016.110
The Journal of the American Osteopathic Association, August 2016, Vol. 116, 553. doi:10.7556/jaoa.2016.110
A healthy 28-year-old woman presented to the family medicine clinic with a worsening, intensely pruritic rash on her flank that had elongated over the past month. She had presented to the office 1 month previously, at the onset of the rash, 7 days after returning from Thailand, where she had sunbathed directly on the sand in a 2-piece swimsuit. She had received a diagnosis of tinea corporis. Clotrimazole was prescribed but provided no relief. Physical examination at the current presentation revealed an erythematous, raised, indurated, serpiginous rash (image) consistent with cutaneous larva migrans. The patient was treated with a 3-day course of albendazole, and the rash resolved. 
Cutaneous larva migrans is seen on skin surfaces that have had direct contact with sand or soil contaminated by hookworm larvae, typically in travelers returning from tropical or subtropical beach destinations.1 The diagnosis is based on exposure history and a characteristic rash.2 Biopsies are not useful, as the cutaneous track does not reliably predict the location of the larvae.2 The condition is self-limiting, but oral albendazole or ivermectin reduce the symptoms and are curative.2 
References
Hochedez P, Caumes E. Hookworm-related cutaneous larva migrans. J Travel Med. 2007;14(5):326-333. [CrossRef] [PubMed]
Parasites - zoonotic hookworm. Centers for Disease Control and Prevention website. http://www.cdc.gov/parasites/zoonotichookworm/health_professionals/. Updated November 25, 2014. Accessed June 20, 2016.