Hookworm-Related Cutaneous Larva Migrans in Northern Brazil: Resolution of Clinical Pathology After a Single Dose of Ivermectin

Hookworm-related cutaneous larva migrans (HrCLM) is a zoonosis caused by larvae from animal hookworms (eg, Ancylostoma species or Uncinaria stenocephala). Once the larvae have penetrated the human skin, they are not capable of passing through the epidermal basal membrane and therefore migrate in the epidermis up to several months [1, 2]. HrCLM is present in many subtropical and tropical countries [3, 4], where its prevalence in resource-poor communities may be up to 4% in the general population [5] but may reach >50% in exceptional situations [6]. HrCLM is also observed in travelers returning from HrCLM-endemic destinations, in whom it is the most frequent dermatologic disorder [3, 4]. In endemic areas, HrCLM is often associated with considerable morbidity, for example through multiple infestations or bacterial superinfection of excoriated tracks [5], and significantly impairs the quality of life of affected individuals [7]. Ivermectin is effective against helminths and ectoparasites and has been used in travelers with cure rates of 77–100% [1, 8]. Travelers, however, often present a single larval infestation and milder clinical manifestations of HrCLM than do individuals from endemic areas [9, 10]. In the present study, we investigated the effects of a single dose of ivermectin on the dynamics of the HrCLM-associated morbidity (determined semiquantitatively) in patients living in a hyperendemic area. At the time the study was conducted, topical thiabendazole or household remedies were used as treatment for HrCLM in this population [11].