CUTANEOUS LARVA MIGRANS --------------------------------------------------------------- Recently also saw a female who developed cutaneous larva migrans on the forehead. Placed her on the oral thiabendazole which we had to order in the US and overnight delivery to the Philippines via Fed Ex. After 2 days had significant clearing of her lesion. Complained of gastritis and occasional loose bowel movement. No experience with topical application of thiabendazole. Jonathan Nevin Yu, MD -------------------- Has any reader had serious side effects from the two day oral course of thiabendazole recommended for cutaneous larva migrans? I had a patient who experienced high fever after taking oral thiabendazole. Treatments: topical 10% thiabendazole lotion (Arch Dermatol 1968:97:325-326) oral albendazole (Clin Exp Dermatol 1989:14: 355-356, Br J Dermatol 1990:122:99-101) Please see a good review article from the Henry Ford hospital (J Am Acad Dermatol 7:353-358, 1988). Yoshiki Taniguchi MD, PhD -------------------- I've had one good response to topical thiabendazole, but no problems with the oral, so I Rx the oral suspension, and for good measure have them apply some of it under occlusion to the affected area over night for a couple of nights. Be sure to ask if patient has had a tetanus shot, and give a booster if no shot in the past 5 years. Kevin C. Smith MD FRCPC -------------------- I have had great success with either the topical or oral form of thiabendazole for cutaneous larva migrans. Both work well. The patients treated were in excellent health. If there is any doubt, the topical works fine -- relief of pruritus is within 24 hours. Robert M. Peppercorn, M.D., -------------------- I recently examined a 50 y.o. male patient who recently visited Brazil and developed a 2 week hx of a serpiginous eruption on the dorsum of both feet. Diagnosis: cutaneous larva migrans. Have the subscribers had experience with topical thiabendazole (it comes in a suspension of 500mg/5ml)? Has any reader had serious side effects from the two day oral course of thiabendazole recommended for cutaneous larva migrans? Ethan D. Nydorf, M.D. -------------------- I see cutaneous larva migrans quite often here in Borneo. Oral albendazole works well in combination with topical thiabendazole. Has not failed yet. If itch is a major problem, I give the larvae a short spray with Ethyl chloride and that stops them moving about for about 24 hrs by which time the topical prep has had time to work. Kids don't always appreciate this though. Topical steroids also help to cut down the inflammation and resultant itch. J S Sidhu -------------------- Topical thiabendazole works great.I recall applying very light liquid nitrogen(makes me feel useful) and then have pts use topical thiabendazole for a couple of days then maybe repeat in a week.I don't have numbers for you, but I believe this to be an effective tx. Pierre Jaffe MD -------------------- I sort of improvised a topical tx years ago: apply the thiabendazole, cover with Saran wrap (I own no stock it it or in anything else), and leave on overnight for one night. I have now used it in several cases with no side effects whatsoever, and, thus far, no tx failures. Safe and effective. Dan Mitchell, MD -------------------- Is thiabendazole in an alcohol base? If so, I wonder if Tegaderm or Cutinova might not be easier to stay put and possibly more effective at occluding? And more expensive. Did you use the topical under occlusion. I wonder if that would obviate the need for po in resistant cases? Diane Thaler -------------------- Topical Thiabendazole works great. I've never needed the oral. Steve Wiener -------------------- We used this topical pretty frequently when I was a resident at UTMB in Galveston in the early 70's. This treatment was discovered by Dr. J. Fred Mullins and Orville Stone, faculty there. I don't recall any problems at all with its use, and it works! Incidentally, these two dermatologists also used oral thiabendazole to cure trichinosis. Philip Hughes, M.D. -------------------- << Have the subscribers had experience with topical thiabendazole (it comes in a suspension of 500mg/5ml)? >> I use it a couple of times per year (actually my patients use it) & haven't had problems. Guy Webster -------------------- when my nephew got cut.larva migrans i tried getting topical thiabendazole here in san diego...none of the pharmacies could get it...where are you guys getting it?...also, ivermectin would be excellent, but isn't available as far as i know, in the u.s.... steve emmet -------------------- Topical Mintezol syrup works well-saturate gauze,occlude with saran wrap qhs x 3 nites. Be sure to overlap the "creeper" by 1/2 inch or more. Oral Mintezole causes frequent GI problems and occas. hemorrhagic cystitis. Hal Rehbein -------------------- Topical thiabendazole BID to the raised areas plus weekly light liquid nitrogen to the raised areas works well. I have not had a treatment failure nor ever had to use oral thiabedazole. Thomas F. Downham II, MD -------------------- I had a patient who had a severe reaction to oral thiabendazole and no reaction to topical. She had a course of mebendazole which was obtained through the CDC. No adverse reactions and the resistant CLM disappeared. Barbara R. Reed, MD -------------------- I have treated a few patients with the oral thiabendazole with no problems whatsoever. I also try a litte LN2 where the migrans seems to be migrating. Joel Schwartz --------------------