What are the dermatologic manifestations of strongyloidiasis?

Updated: Jun 20, 2019
  • Author: Pranatharthi Haran Chandrasekar, MBBS, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Skin penetration by infective larvae can elicit ground itch, a cutaneous eruption of pruritic papulovesicular lesions. Typically, skin penetration is on the feet but may be at any site that contacted infected soil (eg, around the anus [within 12 cm] or anywhere on the trunk and thighs).

Larva currens (racing larvae), the pathognomonic rash of Strongyloides infection, is an intensely pruritic linear or serpiginous urticarial rash that may consist of 1 or more such bands and creeps 5-15 cm/h up the body. The rash, likely an allergic response to the migrating filariform larvae, often manifests as a pruritic wheal or linear urticaria. This dermatologic manifestation may last hours to days but in autoinfection cycles can recur over weeks, months, and years. In an individual who has already been sensitized, a second, creeping, urticarial rash may appear, which is caused by an allergic reaction to the larvae penetrating the skin. Excoriation and impetigo are common.

Rarely, in disseminated strongyloidiasis, a rapidly progressive, diffuse, petechial purpuric eruption may be present secondary to vessel injury during larval migration. [38] Characteristic purpuric periumbilical skin lesions should raise the suspicion for its diagnosis; it often portends a fatal outcome in cancer patients. [39] There have also been case reports of multiple atypical dermatologic presentations in hyperinfection cases. [40]

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