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Letters to the Editor
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Dermatology
Itching question answered?
From Mrs E. P. Wareing, MRPharmS
When I read Jim Barker’s letter (PJ, 3 September, p283), my immediate
diagnosis was “sandworm”, the colloquial term in South Africa
for cutaneous larvae migrans (CML, or creeping eruption).
It is caused by intestinal hookworm eggs from the faeces of cats and dogs
germinating into larvae in warm moist sand, then penetrating human flesh,
usually via the soles of the feet, and migrating under the skin causing
red lines. In South Africa we used to treat this condition with oral thiabendazole
(Mintezole) until the product was discontinued. After that I used a veterinary
product containing thiabendazole which I dispensed as a chemist’s
nostrum for topical application. I had a measure of success but found some
patients complaining of local irritation after using it. Some of my other
colleagues favoured crushing Vermox tablets in a vehicle of white soft
paraffin for topical application. There was also a commercial ointment
available containing piperazine that was marketed for sandworm. After the
launch of Zentel (albendazole) in South Africa, some practitioners prescribed
it to treat CLM although this was a strictly unlicensed indication. A suggested
regimen at the time was a stat dose of 400mg followed by another 400mg
after 10 days.
Current guidelines in the UK, according to Martindale 34th edition and
the British National Formulary 49th edition, are: Tiabendazole — for “single
tracks” topical application of a 10 per cent to 15 per cent suspension.
For “multiple tracks”, oral tiabendazole 25mg/kg twice a day
for two days, repeated after two days if necessary. Albendazole (Zentel)
400mg daily for three, five or even seven days. Single doses of 400mg have
also been reported to be effective.
Ivermectin (Mectizan; MSD) has also been used. Tiabendazole, albendazole
and ivermectin are available only on a named patient basis in the UK.
Since arriving in the UK I have only seen one case of CLM and that was
on the south west coast of Wales — geographically in a similar region
as St Ives, from where Mr Barker hails.
It would be interesting to find out if any other health care professionals
in the region have come across patients with these symptoms.
Elaine Wareing
Newark, Nottinghamshire |
The
Pharmaceutical Journal