A 6-year-old boy presented with a 1-month history of an intensely pruritic “rash” that involved the left dorsal foot and left lower leg (Figure). He had a recent history of walking barefoot on a beach in south Florida where dogs are allowed.
The patient’s initial presentation involved an erythematous serpiginous tract on the dorsomedial aspect of the distal left foot. Over the next 4 weeks, the lesion extended from the foot all the way up the lower leg in a serpentine fashion. The migrating lesion stopped just below the knee on the medial aspect of the lower leg.
The advancement of the serpiginous plaque prompted a visit to the emergency department (ED). Suspicious of cutaneous larva migrans (CLM), the ED personnel prescribed an oral anthelmintic drug, albendazole, 400 mg taken daily for 7 days. The patient also was referred to a dermatology office for further evaluation.
At the evaluation, physical examination revealed a systemically well-appearing 6-year-old boy. An erythematous, approximately 3-mm-wide tract extended from the dorsomedial aspect of the distal left foot to the medial aspect of the proximal lower leg. Even though treatment was almost complete, the lesion continued to look active, with papules and erythema.
Continuation of the albendazole prescribed by the ED was recommended. In addition, cryotherapy was used 1 cm from the leading edge of the visible tract. Hydroxyzine, 7.5 mL at bed time, as needed, was advised for the persistent itching. Tips for prevention, including wearing shoes when walking in sandy areas and avoiding beaches cohabited by dogs, were given to the patient’s parents.
A 2-week follow-up visit was arranged. On the visit, the patient reported a resolution of his pruritus. The tract looked hypopigmented and was healing well.