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May 2010

Multiple Pruritic Erythematous Papules on the Trunk After a Trip to Thailand—Diagnosis

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Arch Dermatol. 2010;146(5):557-562. doi:10.1001/archdermatol.2010.78-b

We found nonspecific mononuclear cell inflammation with eosinophilic infiltration in the dermis. A parasite was seen focally in a cavity within the epidermis, lined by necrotic keratinocytes (Figure 2).

Cutaneous larva migrans presents most commonly as an erythematous serpiginous “creeping eruption” but may also take the form of hookworm folliculitis and urticarial papules.1,2 This localized, pruritic, erythematous, papular eruption of acral regions is colloquially known as “ground itch,” and the lesions represent the primary inoculation sites for third-stage larvae.3 In a review of 44 patients,4 most had classic creeping eruption; only 2 patients had vesicular lesions, initially misdiagnosed as viral infections; and 1 patient presented with multiple nodules on the buttocks. Larval forms of skin-invading dog and cat hookworms, such as Ancylostoma caninum, Ancylostoma braziliense, and Necator americanus, are most frequently implicated.4 Rarely, Uncinaria stenocephala (European dog hookworm), Bunostomum phlebotomum (cattle hookworm), and Gnathostoma doloresi have also been identified.3

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