Journal Information
Vol. 109. Issue 7.
Pages 659-660 (September 2018)
Vol. 109. Issue 7.
Pages 659-660 (September 2018)
Case and Research Letters
DOI: 10.1016/j.adengl.2018.06.007
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Facial Cutaneous Larva Migrans Acquired in Spain
Larva migrans cutánea facial de origen autóctono en España
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C. Durán-Vian
Corresponding author
cduranvian@gmail.com

Corresponding author.
, I. Vilanova-Udaniz, B. Castro-Gutierrez, M.A. González-López
Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, España
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Table 1. Autochthonous Cases of Larva Migrans in Spain Between 1990 and 2017.
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Cutaneous larva migrans is a parasitic disease caused by the penetration of hookworms that migrate across the epidermis. It usually occurs when the skin comes into contact with soil contaminated with animal feces containing these worms. The vast majority of larva migrans cases are imported from tropical or subtropical countries, and very few autochthonous cases have been reported in Europe.1 Six recent cases have been reported in Spain (in Burgos, Gipuzkoa, and Asturias).2–4 We describe what we believe is the first case of autochthonous larva migrans in the autonomous community of Cantabria in northern Spain.

A 4-year-old girl presented in early summer with a 5-day history of a pruritic, migratory cutaneous lesion in the nasal region. The girl's mother confirmed that they had not travelled outside Cantabria in the past few months but mentioned that her daughter had been in contact with sand at a local beach on several sunny days. The skin examination showed an erythematous, slightly raised, serpiginous lesion on the nasal dorsum extending into the left paranasal region (Fig. 1). In view of these characteristic findings, we established a diagnosis of larva migrans and started treatment with albendazole 400mg/d for 3 days. The lesion improved gradually and cleared completely within a week.

Figure 1.

Erythematous, serpiginous trail caused by cutaneous larva migrans involving the nasal dorsum and left paranasal region.

(0.03MB).

Ancylostoma braziliense is the main parasite responsible for cutaneous larva migrans. Most hookworm species live in warm, wet climates and are therefore found more often in the digestive system of animals (mainly dogs and cats) living close to the equator.1

Diagnosis is essentially clinical and is based on the detection of pruritic, serpiginous lesions that creep forward at one end. The larva is located approximately 1 or 2cm ahead of the advancing lesion and biopsy samples are therefore unlikely to show parasite structures.3 Cutaneous larva migrans mainly affects the lower extremities and is generally more common in children than in adults.5 There have been very few reports of lesions involving the face.6

The current case prompted us to review the literature, dating mainly from the past decade, in search of other autochthonous cases. We identified 15 cases (Table 1), none involving the face. One interesting observation is that all the recent cases were from the north of Spain.3,4 It is also noteworthy that over 20 autochthonous cases of larva migrans have been reported in Europe in recent years,2 suggesting that the temperate ocean climate might be conducive to the biological cycle of these nematodes.

Table 1.

Autochthonous Cases of Larva Migrans in Spain Between 1990 and 2017.

No.  Author  Year  Place  History  Age, y  Location  Treatment 
Nicol M et al.  1990  Malaga  Botanical gardens  17  Foot  Topical thiabendazole 
Colomina J et al.  1994  Valencia  Cats  13  Foot  Oral thiabendazole 
Obanda I et al.  1997  Cordoba  Rural  Child  Oral thiabendazole 
Sabat M et al.  2002  Barcelona  22  Hand  Oral thiabendazole 
Fernandez M et al.  2003  Oviedo  Rural  Foot  Oral thiabendazole 
Santiago JL et al.  2009  Pyrenees  River bank  31  Buttock  Oral albendazole 
Panes A et al.  2011  Gipuzkoa  Hiking with sandals  60  Foot  Oral albendazole 
Castro J et al.  2014  Mediterranean coast  Beach  28  Shoulder  Oral albendazole 
Gutierrez Garcia C et al.  2016  Burgos  Swimming pool, cats  14  Foot  Oral albendazole 
10  Gutiérrez García C et al.  2016  Madrid  Grass and cats  Ankle  Oral mebendazole 
11  Hidalgo García et al.  2016  Asturias  Forest, sand  39  Hand  Oral albendazole 
12  Panes A et al.  2016  Gipuzkoa  Vegetable patch  63  Trunk and arms  Oral albendazole 
13  Panes A et al.  2016  Gipuzkoa  Vegetable patch  79  Foot  Oral albendazole 
14  Panes A et al.  2016  Gipuzkoa  Hiking  39  Leg  Oral albendazole 
15  Durán Castro C et al.  2017  Cantabria  Beach  Face  Oral albendazole 

Environmental parasitology studies have identified changes in the frequency and geographic distribution of hookworms, probably in response to climate change and the “tropicalization” of the European climate.7,8

In conclusion, this new case of cutaneous larva migrans in Spain highlights the need to establish opportune preventive measures to prevent a greater incidence of autochthonous cases.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

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Please cite this article as: Durán-Vian C, Vilanova-Udaniz I, Castro-Gutierrez B, González-López MA. Larva migrans cutánea facial de origen autóctono en España. Actas Dermosifiliogr. 2018;109:659–660.

Copyright © 2017. Elsevier España, S.L.U. and AEDV
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