Efficacy of Albendazole Ointment on Cutaneous Larva Migrans in 2 Young Children

SIR—Cutaneous larva migrans, caused by subcutaneous migration of animal hookworm larvae, is now easy to treat orally with ivermectin or albendazole [1]. However, both of these drugs are contraindicated in young children, and topical treatments must thus be considered. Freezing the leading edge of the cutaneous trail should be avoided, because it is both ineffective and painful. Topical application of 10%–15% thiabendazole solution or ointment to the affected area is effective, but thiabendazole is no longer marketed by the manufacturer. This prompted us to test a 10% albendazole ointment in 2 children who presented with cutaneous larva migrans. Patient 1 was 2-year-old boy weighing 11 kg who was seen at Hopital Pitie-Salpêtrière (Paris, France) in May 2003. He had traveled with his parents to Senegal from 1 to 7 March 2003. He reported a mobile pruritic skin lesion on the left buttock that had been present since 28 April 2003. A physical examination on 3 May 2003 revealed a serpiginous erythematous cutaneous track ∼10 cm long on the left buttock. We treated the patient with a 10% albendazole ointment, prepared by crushing three 400-mg tablets of albendazole in 12 g of petroleum jelly and applied thrice daily for 10 days. The cutaneous lesion disappeared within a week after treatment was initiated, and no relapses occurred during >6 months of follow-up. Patient 2 was a 2-year-old girl weighing 10 kg who first presented in September 2003. She had traveled with her parents to the Dominican Republic from 10 to 31 August 2003. She first reported a mobile pruritic skin lesion on the left foot on 10 September. A physical examination on 13 September revealed a serpiginous erythematous cutaneous track ∼5 cm long on the left foot. She received the same course of treatment as patient 1, and the lesion disappeared within a week after treatment was received. Three months later, patient 2 presented with a 3-cm serpiginous erythematous lesion on the right shoulder. She received the same topical treatment as before, and the lesion disappeared within a week after treatment was received. No further relapses occurred during 2 months of follow-up. These findings suggest that topical application of 10% albendazole ointment 3 times per day for 10 days is a safe and effective treatment for cutaneous larva migrans. Although patient 2 subsequently developed a second episode of cutaneous larva migrans, this occurred in a different area of her body and therefore cannot be attributed to failure of the initial treatment. In addition, the same treatment was as effective in the second episode as it had been in the first, and no further episodes have occurred. These findings suggest that 10% albendazole ointment is an effective treatment for cutaneous larva migrans. This topical treatment is particularly suited to children, for whom available oral treatments are contraindicated.