INTRODUCTION

Cutaneous hookworm larva migrans (CLLM), a parasitic skin disease caused by Ancylostoma brasiliensis (a parasite of dogs) and Ancylostoma caninum (a parasite of cats), is a serious public health problem in sub-Saharan Africa due to its endemicity. The follicular form, caused by the same parasites, is rarely reported. Both forms of infestation are favored in tropical regions by humidity and the host animals, particularly cats and dogs. Herein, we report six cases of the rare form of hookworm folliculitis, all of which were associated with the presence of serpiginous burrows characteristic of CLLM, thus facilitating clinical diagnosis.

CASE REPORT

The study included four men and two women, ranging in age from 27 to 75 years. All patients consulted at the Niamey National Hospital during the rainy season (a period of humidity and heat) between four days and five weeks after the onset of their lesions. Pruritus was the predominant and consistent symptom. Two of these patients underwent treatment without success, including antibiotics, topical and systemic corticosteroids, antihistamines, and antiseptics. Dermatological examination revealed numerous papule-like or papulopustular lesions, some with excoriation, associated with several serpiginous furrows, most of which were short, not exceeding 3 mm. The lesions were located in the dorsolumbar region in three patients (Fig. 1a), on one buttock in one patient (Fig. 1b), and on the breasts in both women (Fig. 1c).

Figure 1: (a) Dorsolumbar location of the lesions before treatment. (b) Location of the lesions on the left buttock. (c) Location on the left breast. (d) Disappearance of the lesions after treatment, with a four-week follow-up.

Table 1 lists the sociodemographic and clinical characteristics of the patients. The general physical examination was normal in all patients. All patients achieved a cure after taking one 400 mg albendazole tablet daily for three consecutive days. A four-week follow-up of all patients revealed no relapse or treatment-related side effects (Fig. 1d).

Table 1: Sociodemographic and clinical characteristics.

DISCUSSION

The first case of hookworm folliculitis was reported in 1991 by Miller et al. [1]. As noted in the literature [1–4], in our patients, pruritus was almost constant and often intense. Our six cases of hookworm folliculitis were observed during periods of humidity and heat, as reported in certain regions [2,4,5], sometimes with the presence of dogs or cats [6,7]. In most cases [1–3,8], clinical examination, as in our patients, revealed a highly variable number of papular or papulopustular lesions, rarely associated with serpiginous burrows, facilitating diagnosis. Some authors [2,3,5,8] have used histological examination after a skin biopsy, which revealed foci infiltrated by lymphocytes and eosinophils. The location of the lesions was frequently in the buttocks [1-3 5,7], while it was in one case in our patient.

We observed the involvement of several body parts (thoracolumbar region, breasts, thighs, and arms), as reported by some authors [1,4,6,7]. We also noted, as reported in the literature [3–5], that some patients had undergone both local and systemic treatments prior to diagnosis. Most of the treatments reported by some authors [1–3,5,7], as in our cases, successfully used albendazole 400 mg, although the duration of treatment ranged from 3 to 7 days. Some authors have successfully used ivermectin as a single 12 mg dose [1,4,6,8].

CONCLUSION

Hookworm folliculitis is a rare parasitic infection whose clinical diagnosis is facilitated by its association with cutaneous larva migrans lesions. Despite the frequent association with cutaneous larva migrans, its management responds effectively with albendazole 400 mg as a single daily dose for three consecutive days; however, a single dose of ivermectin yields better results compared to a single dose of albendazole 400 mg.

REFERENCES

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