10/13/2022

“The Itch
at the
01
GENERAL DATA
Beach”
Group A

GROUP MEMBERS PATIENT GENERAL DATA

Name Gender
A.F.M Female
1. ABANGON, ABDURAFFI U. 6. ABRAHAM, AR-RAYYEED N Address
2. ABAO, PEARL GEESREAL THEA H. 7. ABRASALDO, MIGUEL KYLE LUMAKIN Age
032 Blk 4, Lot 8 Doña Milagros Village,
3. ABDULMALIK, MUAWIYA 8. ACEBES, JESSAREE NINGASCA 23 years old Barangay 20-B, Davao City
4. ABELLERA, HANNAH GENE FAITH B. 9. AGALIN, YASIERAH KHALIL
5. ABPI, MUHAMMAD MONSOUR DUMAMA 10. AGUDO, EDREI LINZEI MONIQUE N.
Birth Date Birth Place Civil Status
09/06/1999 Kidapawan City Single

Nationality Occupation
Religion
Filipino Aircraft Mechanic
Catholic

TABLE OF CONTENTS CHIEF COMPLAINT

01 General Data
02 History and
Physical
Examination Plaque with scaling
03 Diagnosis and
Differentials
04 Discussion

05 Management
and Prognosis

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PAST MEDICAL HISTORY

02
Operations/Surgery: None
Illnesses: None
Food/Drug Allergies: None
Medications: None

HISTORY & Habits: Regularly takes a bath and uses safeguard.

Atopic History: (-) Bronchial Asthma, (-) Allergic Rhinitis, (-) Atopic Dermatitis

PHYSICAL Family History: (+) Hypertension, (+) Diabetes Mellitus, (-) Bronchial Asthma

EXAMINATION
Obstetrics & Gynecology History: No information provided

HISTORY OF PRESENT ILLNESS SOCIAL HISTORY

● 1 month prior to consultation
● Occupation: Aircraft Mechanic
○ Presence of multiple vesicles, plaques, and macules ● Non-smoker
located on her left lateral leg ● Occasional alcoholic beverage drinker
○ Lesion started 5 days after her beach trip at Dahican, Mati
○ Self-medicated with tea tree oil and clobetasol propionate
(Dermovate) with no relief
○ Also used safeguard soap to wash the affected area
○ (+) Intense pruritus
○ (-) Pain
○ No consultation was done

HISTORY OF PRESENT ILLNESS REVIEW OF SYSTEMS

● In the interim ● (+) Pruritus
● (-) Fever
○ Lesion progressed into an ill-defined plaque with scaling ● (-) Pain
and adjacent to it is a solitary papule with erythematous ● (-) Chest pain
serpiginous plaque ● (-) Dyspnea
● (-) Abdominal pain
○ Serpiginous plaque was migrating several centimeters per ● (-) Cough
day ● (-) Colds
○ (+) Intense pruritus ● (-) Lesions in other parts of the body
● (-) Lymphadenopathy
○ (-) Pain
● Morning prior to consultation
○ Persistence of symptoms prompted the patient to seek
consultation

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PERTINENT FEATURES PHYSICAL EXAMINATION

Pertinent Positives Pertinent Negatives
● (+) Hyperpigmented plaque with ● (-) Other lesions found in other
scaling on left lateral leg parts of the body
● (+) Erythematous migratory ● (-) Lymphadenopathy
● (-) Pain
serpiginous plaque located on the
● (-) Fever
left lateral leg
● (+) Pruritus
● History of going to the beach

Solitary ill-defined hyperpigmented plaque with Adjacent to it is a well-defined erythematous migratory

scaling on left lateral leg. serpiginous plaque located on the left lateral leg.

PHYSICAL EXAMINATION PHYSICAL EXAMINATION

General Physical Examination
Awake, Alert, Comfortable, Not in Respiratory Distress

Weight: No information provided

Height: No information provided

Dermatologic Physical Examination

Solitary ill-defined hyperpigmented plaque with scaling and adjacent to it is a well-
defined erythematous migratory serpiginous plaque located on the left lateral leg

PHYSICAL EXAMINATION

03
DIAGNOSIS &
DIFFERENTIALS
Multiple ill defined erythematous vesicles, plaques,
and macules located on the left lateral leg.

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Primary Impression: Cutaneous Larva Scabies

Migrans
Rule in Rule out
The diagnosis is supported by the patient’s history of fieldwork at her the airforce and field
exposure in Mati, and “mosquito bite” which can be the larvae entering through direct
contact during the exposure. The appearance of the lesion, 5 days after the exposure, is also
within the typical time frame of CLM. ● Papules and vesicles ● Intense nocturnal pruritus
Dermal physical examination shows solitary, erythematous, raised, thin migratory ● Intense pruritus ● Excoriations and eczematous
serpiginous, linear and intensely pruritic lesion in the left lateral leg, which are classic
● Serpiginous plaque with dermatitis
manifestations of CLM. Vesicles and papules, which are present in the patient, are present in
scaling ● Burrow/s
15% of patients with CLM. Plaques and urticaria can also manifest in CLM. The etiologic
agent is also endemic in the Philippines.
● Other members of the family
do not present with pruritus

Larva Currens Cercarial Dermatitis

Rule in Rule out

Rule In Rule out

● Erythematous, migratory ● (-) recurrent and transient, ● Erythematous, papular rash ● Fever
serpiginous, and intensely rapidly moving ● Pruritus ● Cough
pruritic lesions ● Lesion does not disappear ● Hyperpigmented lesions ● Myalgia
within hours ● Headache
● Etiologic agent is endemic in
● Lower extremities ● Fatigue
the Philippines
● (-) GI Symptoms ● Urticaria
● onset of the disease ● History of exposure to
● typically appear months to freshwater
years after exposure

Tinea Corporis Erythema Annulare Centrifugum

Rule in Rule out

Rule in Rule out

● Erythematous plaque with ● Annular plaque with central
scaling clearing
● Well-demarcated plaque with ● Raised, pruritic, serpiginous
● Pruritus ● Advancing outer
scaling lesions
● Serpiginous pattern erythematous edge with
● Vesicles on the borders of the ● Location of the scaling is not
disease at the center ● Involves the lower extremity trailing scaly edge
● Papules

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04 LIFE
CYCL
DISCUSSION E

Centers for Disease Control and Prevention. (2019, September 17). CDC - Zoonotic Hookworm - Biology. Centers for Disease Control
and Prevention. Retrieved October 6, 2022, from https://www.cdc.gov/parasites/zoonotichookworm/biology.html

EPIDEMIOLOGY PATHOPHYSIOLOGY
most commonly found in tropical ● Infection results from direct skin penetration by infective larvae of
and subtropical areas, especially animal hookworms.
● Larvae migrate up to several centimeters
● the southeastern United
a day, usually between the stratum
States
germinativum and stratum corneum, and
● Caribbean
induce a localized eosinophilic
● Africa
inflammatory reaction
● Central and South America,
● Animal hookworm larvae cannot mature
● India
beyond the larval stage in humans; they
● Southeast Asia.
are unable to invade deeper tissues and
die after days to months.

ETIOLOGY CLINICAL FINDINGS

● is most commonly caused by animal
hookworms, and in particular ● Typical skin lesions appear 1 to 5 days after exposure
Ancylostoma braziliense ● Erythematous, raised, and vesicular, linear, or serpentine cutaneous
● Other skin penetrating hookworm trail that progresses at a rate of 2 to 3 cm per day
larvae that produce similar disease ● Vesicular, papular or bullous lesions may be seen (15% of patients)
include ● Larvae advance a few millimeters to a few centimeters daily.
● Feet and buttocks (most common sites)
○ A. caninum
○ Uncinaria stenocephala ● Last between 2-8 weeks but may last up to 2 years
○ Bunostomum phlebotomum ● Systemic signs and symptoms (wheezing, dry cough, urticaria) are
rare.

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PHYSICAL EXAMINATION
ORDERED FOR THE PATIENT:
❏ Complete Blood Count-
❏ Fecalysis
❏ Urinalysis
Serpiginous, thin, linear, containing serous fluid may be single or
raised, tunnel-like multiple
lesions, 2–3 mm wide

DIAGNOSTIC METHODS COMPLICATIONS

Staphylococcus aureus & Hypersensitivity Syndrome:

Streptococcal species dyspnea, wheezing, cough, and fever

Larval migration through lung tissue

SKIN BIOPSY SKIN SCRAPINGS DERMOSCOPY

SECONDARY BACTERIAL LOEFFLER SYNDROME
https://www.cdc.gov/dpdx/monthlycasestudies/2020/c Le Joncour, A., Lacour, S.A., Lecso, G., Regnier, S., Sandhu S, Bhatnagar A, Suhag D. Dermoscopy of
ase523.html Guillot, J., & Caumes, E. (2012). Molecular cutaneous larva migrans. Indian J Dermatol Venereol
characterization of Ancylostoma braziliense larvae in a Leprol doi: 10.25259/ IJDVL_316_2021
patient with hookworm-related cutaneous larva
migrans. The American journal of tropical medicine and
hygiene, 86 5, 843-5 . INFECTIONS

Other laboratory tests for Helminthic Infections:

COMPLETE BLOOD COUNT

(Eosinophilia)
Serum Ferritin
(Iron-deficiency Anemia)
Chest Radiograph
(pulmonary involvement
[reticulonodular infiltrates])
05
MANAGEMENT,
Serologic Assay Molecular Testing by PCR Fecalysis
PREVENTION,
PROGNOSIS

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MANAGEMENT: Diagnostic Work-up PROGNOSIS

LAB TEST RATIONALE RESULT

CBC To check eosinophilia and Eosinophilia

presence of other infections
In almost all cases, the prognosis of CLM is
Fecalysis To assess for presence of eggs
or parasites; ruling out other
No eggs / parasite seen
(NOPS)
entirely benign, although the migrating
larvae can cause considerable distress and
etiologies Strongyloides
stercoralis and Trichobilharzia
spp.
discomfort
Urinalysis To check for infection; rule out Clear, Yellow
other conditions No crystals
No cast
No bacteria

MANAGEMENT: Treatment REFERENCES

Oral Albendazole 400 mg once daily taken for 3 days is the primary therapy for adult
patients having cutaneous larva migrans
● Andrews’ Diseases of Skin Clinical Dermatology 12th Edition.
Alternative drug treatments include Ivermectin 200 ug/kg daily for 1-2 days, topical Chapter 20 pg 430-431.
thiabendazole, and topical Albendazole 10% ● Feldmeier H, Singh Chhatwal G, Guerra H. Pyoderma, group A
streptococci and parasitic skin diseases -- a dangerous
Betamethasone lotion can be given to relieve inflammation and itching. relationship. Trop Med Int Health. 2005 Aug;10(8):713-6.
● Fitzpatrick’s Dermatology 9th Edition. Chapter 177 pg 3251-3266.
Bilastine can also be given to treat possible urticaria

Advice the patient to continue doing her daily hygiene and apply mild soap and
emollients to the affected area

MANAGEMENT: Prevention

Avoid walking barefoot, sitting, or lying on wet soil or sand THANK

Use of footwear or boots
YOU!
Use of cover when sitting or lying on the ground

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Deworm pets