Bullous Cutaneous Larva Migrans of the Palm

A 24-year-old woman presented with 1-month history of intensely pruritic creeping eruption over her right palm. Examination revealed a slightly raised, thread-like, curvilinear tract with a 2 cm × 2 cm bulla over the left palm. There was a history of playing in the beach sand 1 month before the onset of eruption. Systemic examination did not reveal any abnormality. Her baseline hematological and biochemical investigations were within normal limits. Stool analysis was negative for parasites. On the basis of the history and clinical picture, a diagnosis of bullous cutaneous larva migrans (CLM) was made. The patient was treated with a single dose of oral ivermectin 12 mg and 3 days albendazole 400 mg daily for 3 days, along with oral antihistamines. The lesions showed resolution in 10 days. The cytological examinations of the bulla often reveal lymphocytes, neutrophils, and eosinophils. Avoiding contact with contaminated soil is the most appropriate preventative measure. Oral agents such as albendazole, thiabendazole and ivermectin represent the first line of treatment of bullous CLM.