A 29-year-old man living in Singapore developed itching vesiculobullous lesions with serpiginous erythematous tracks on his toes (Figure 1) and soles, one week after a trip to Tioman Island, Malaysia. The lesions were unresponsive to topical corticosteroids prescribed by an emergency physician and antifungal creams prescribed by the patient’s family doctor. The patient consulted a teledermatology service based in Paris, France, sending digital images via a secure site to a dermatologist (C.B.), who diagnosed vesiculobullous cutaneous larva migrans. The cutaneous lesions resolved within a week of completing a three-day course of oral albendazole, 400 mg daily, prescribed by a dermatologist in Singapore.
Figure 1:
Erythematous, vesiculobullous serpigenous tracks, consistent with cutaneous larva migrans, on the toes of a 29-year-old man.
Cutaneous larva migrans, or “creeping eruption,” is a common dermatological condition among travellers returning from beach vacations in tropical countries, and is caused by different species of hookworms.1,2 It is a clinical diagnosis, with typical lesions consisting of pruritic, erythematous, raised, linear or serpiginous tracks that, varying with the species, move at the rate of 1 mm–2 cm a day, over the feet, buttocks and anogenital regions.1 Vesiculobullous forms with single or multiple vesicles or bullae are round or oval in shape, and typical tracks are observed in 10% of patients.1 The differential diagnosis includes bacterial infection, tinea pedis and contact dermatitis.1 Treatment options include albendazole (available in Canada through Health Canada’s Special Access Programme) taken orally, mebendazole, ivermectin and topical thiabendazole.1,3 Our case shows how telemedicine can overcome barriers to accessing specialized medical knowledge, not only for patients but for health care providers.4
Clinical images are chosen because they are particularly intriguing, classic or dramatic. Submissions of clear, appropriately labelled high-resolution images must be accompanied by a figure caption. A brief explanation (300 words maximum) of the educational importance of the images with minimal references is required. The patient’s written consent for publication must be obtained before submission.
Footnotes
Competing interests: Claude Bachmeyer used the telemedicine program described in this article, but has no financial interests in it. None declared by Alicia Moreno-Sabater.
This article has been peer reviewed.
The authors have obtained patient consent.
References
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