ARTICLE
Cutaneous larva migrans (CLM) is an infestation caused by the
penetration and migration in the skin of nematode larvae: Ancylostoma
braziliense and Ancylostoma caninum are the species most frequently
involved [1].
CLM is characterized clinically by slightly raised tracks: they are
erythematous, linear or, more often, serpiginous, ramified and intertwined,
of variable length (sometimes many centimetres) and width (generally 2-4
mm) [1].
CLM may be treated by physical means (ethyl chloride and cryotherapy),
topical drugs (tiabendazole) and oral drugs (tiabendazole, albendazole
and ivermectin). Physical treatments are ineffective in extensive and/or
multiple lesions. Topical tiabendazole is effective, but it is not on
the market in many countries. It is also effective orally, but it frequently
causes side effects [1]. Ivermectin was first used in the therapy of CLM
in 1992 by Caumes et al. [2]: despite the small number of patients
treated [3-5], ivermectin appears to be very effective in CLM; however,
in several countries it is on the market only for use in veterinary medicine.
In 1997 we published the preliminary results of a clinical study on
the use of oral albendazole, according to a new therapeutic regimen (400
mg/day for 7 days), in 11 patients affected by cutaneous larva migrans,
characterized by extensive and/or multiple lesions [1].
We present now the final results based on a group of 24 patients.
Patients and methods
The case list consists of 24 Caucasian patients (13 males and 11 females,
aged between 17 and 68 years; mean age: 31.1 years) with CLM characterized
by extensive and/or multiple lesions.
In all the patients at least one foot was involved. Other localizations
were breasts (2 patients), abdomen (2 patients), buttocks (2 patients),
thighs (2 patients) and calf (1 patient).
The infestation was contracted in Mexico (6 patients), Jamaica (4 patients),
Cuba (2 patients), Thailand (2 patients), Malaysia (2 patients), and Greece,
Dominican Republic, Barbados, Saint-Martin, Anguilla, Antigua, Kenya and
Zanzibar (one patient each).
The diagnosis was based on the history and clinical picture. Moreover,
13 patients (54.1%) were subjected to epiluminescent microscopy. Skin
biopsy was not performed.
No patient had been previously treated with topical or systemic drugs
or any physical modality.
The patients were subjected to laboratory examinations (among others:
full blood count with total eosinophil count, total IgE, inflammatory
tests, liver tests, renal tests and urinalysis) before and after the therapy.
Albendazole was administered orally at a dosage of 400 mg/day for 7 days.
No other topical or systemic drug was used nor any physical treatment.
The patients were followed up for at least 3 months after the end of the
therapy.
Results
Epiluminescent microscopy was positive in 1 out of 13 patients (7.6%).
All patients were cured at the end of the therapy. The disappearance
of pruritus was observed after 2-3 days and of skin lesions after 6-7
days of therapy.
No side effect was either complained of or observed. No laboratory abnormality
was recorded.
No recurrence was observed.
Discussion
Albendazole is a benzoimidazole drug which has been successfully used
in nematode and cestode infestations [1]. The mechanism of action of albendazole
is still not completely known and a number of hypotheses have been advanced.
The degeneration of cytoplasmic microtubules of the helminth, with release
of proteolytic and hydrolytic enzymes in the cytoplasm and consequent
cellular lysis, represents the most likely hypothesis [1].
Albendazole was employed for the first time in the therapy of CLM in
1982 by Coulaud et al. [6], who successfully treated 18 patients.
Since then, as far as we know, more than 100 cases have been published
[4, 7-26]. The drug was effective in the great majority of patients. However,
both the daily dosage and the duration of the therapy have not yet been
defined in a definite way. In fact, daily dosages used ranged between
400 and 800 mg and the duration of the therapy ranged from 1 to 7 days.
We decided to use the drug at the dosage of 400 mg/day for 7 days because
of reports of lack of cure or recurrences even after 5 days of therapy
[8, 12, 13]. Furthermore, we had previously observed several patients
in whom a 5-day therapy was not sufficient [unpublished data].
Our case list, smaller only than that of Sanguigni
et al. [12], confirms that albendazole is effective in the treatment
of CLM characterized by extensive and/or multiple lesions. Its action
is rapid, with the complete disappearance of pruritus after 2-3 days and
the cutaneous lesions after 6-7 days of therapy. The anti-pruritic activity
allows us to avoid the use of systemic anti-histamines. Furthermore, this
new therapeutic regimen avoids recurrences. Finally, the longer duration
of the therapy is not accompanied by the appearance of more severe and/or
new side effects and/or laboratory abnormalities.
On the basis of these results, we believe that albendazole represents
the drug of choice in the therapy of CLM characterized by extensive and/or
multiple lesions.
REFERENCES
1. Rizzitelli G, Scarabelli G, Veraldi S. Albendazole: a new therapeutic
regimen in cutaneous larva migrans. Int J Dermatol 1997;
36: 700-3.
2. Caumes E, Datry A, Paris L, Danis M, Gentilini M, Gaxotte P. Efficacy
of ivermectin in the therapy of cutaneous larva migrans. Arch Dermatol
1992; 128: 994-5.
3. Louis FJ, De Quincenet G, Louis JP. Intérêt de l'ivermectine
en prise unique dans le traitement du syndrome de larva migrans
cutanée. Presse Med 1992; 21: 1483.
4. Caumes E, Carriere J, Datry A, Gaxotte P, Danis M, Gentilini M. A
randomized trial of ivermectin versus albendazole for the treatment
of cutaneous larva migrans. Am J Trop Med Hyg 1993; 49:
641-4.
5. Van Den Enden E, Stevens A, Van Gompel A. Treatment of cutaneous
larva migrans. N Engl J Med 1998; 339: 1246-7.
6. Coulaud JP, Binet D, Voyer C, Samson C, Moreau G, Rossignol JF. Traitement
du syndrome de larva migrans cutané « larbish »
par l'albendazole. A propos de 18 observations. Bull Soc Pathol Exot
1982; 75: 534-7.
7. Di Rosa S, Blandino E, Quartararo P, Sciacca R, Mascellino R, Rini
GB. Un caso di larva migrans cutanea trattato con albendazolo.
An imported case of cutaneous larva migrans. Giorn Mal Inf Parass
1987; 39: 499-501.
8. Marangi M, Teggi A, Sanguigni S. Il trattamento della sindrome da
larva migrans cutanea con albendazolo. Cutaneous larva migrans
treated with albendazole. Giorn Mal Inf Parass 1988; 40: 42-3.
9. Williams HC, Monk B. Creeping eruption stopped in its tracks by albendazole.
Clin Exp Dermatol 1989; 14: 355-6.
10. Orihuela AR, Torres JR. Single dose of albendazole in the treatment
of cutaneous larva migrans. Arch Dermatol 1990; 126: 398-9.
11. Jones SK, Reynolds NJ, Oliwiecki S, Harman RRM. Oral albendazole
for the treatment of cutaneous larva migrans. Br J Dermatol
1990; 122: 99-101.
12. Sanguigni S, Marangi M, Teggi A, De Rosa F. Albendazole in the therapy
of cutaneous larva migrans. Trans R Soc Trop Med Hyg 1990;
84: 831.
13. Marangi M, Sanguigni S, Cultrera R, Fratto N, Teggi A, Martire F,
De Rosa F. Trattamento della sindrome da larva migrans cutanea
con albendazolo. Esperienze personali. Med (Firenze) 1990; 10:
291-2.
14. Davies HD, Sakuls P, Keystone JS. Creeping eruption. A review of
clinical presentation and management of 60 cases presenting to a tropical
disease unit. Arch Dermatol 1993; 129: 588-91.
15. Kollaritsch H, Jeschko E, Wiedermann G. Albendazole is highly effective
against cutaneous larva migrans but not against Giardia
infection: results of an open pilot trial in travellers returning from
the tropics. Trans R Soc Trop Med Hyg 1993; 87: 689.
16. Jones SK. Cutaneous larva migrans "recurrens". Br
J Dermatol 1994; 130: 546.
17. Albanese G, Di Cintio R, Beneggi M, Crippa D, Galbiati G, Nicoletti
A, Rossi E, Sala G. Larva migrans in Italy. Int J Dermatol
1995; 34: 464-5.
18. Wong-Waldamez A, Silva-Lizama E. Bullous larva migrans accompanied
by Loeffler's syndrome. Int J Dermatol 1995; 34: 570-1.
19. Jansen T, Schaller M, Meurer M, Plewig G. Larva migrans cutanea.
Z Hautkr 1995; 70: 168-72.
20. Lavaroni G, Briscik E, Kokelj F. Larva migrans cutanea trattata
con albendazolo. Descrizione di due casi. G Ital Dermatol Venereol
1995; 130: 405-7.
21. Di Carlo A, Vassallo D, Iacovelli P, Leone G. Due casi di creeping
disease: risultati del trattamento con albendazolo. Chron Derm
1995; 5: 225-31.
22. Pauluzzi P, Magaton Rizzi G, Mattighello P. Larva migrans:
report of three cases. Therapeutic advice. J Eur Acad Dermatol Venereol
1996; 6: 89-91.
23. Celano G, Ruatti P. Larva migrans cutanea (creeping eruption)
osservazioni su un caso autoctono trattato con albendazolo. Chron Derm
1996; 6: 517-28.
24. Loughrey MB, Irvine AD, Girdwood RWA, McMillan JC. Cutaneous larva
migrans: the case for routine oral treatment. Br J Dermatol
1997; 137: 149-61.
25. Aste N, Fumo G, Ferreli C, Biggio P. Larva migrans treated
with a single dose of albendazole. J Dermatol Treat 1997; 8: 147.
26. Pau M, Fumo G, Aste N. Larva migrans cutanea: un caso autoctono
trattato con albendazolo. Ann Ital Dermatol Clin Sper 1997; 51:
56-8.
|
Version imprimable