Hookworm Infection: Creeping Eruption

What is creeping eruption?

Creeping eruption is a skin infection caused by hookworms. It is also called sandworm disease.

Creeping eruption causes severe itching, blisters, and a red growing, winding rash. The rash can grow about 1/2 to 3/4 inches per day. The infection often appears on parts of the body that have been exposed to the contaminated ground. These include the feet, legs, buttocks, or back.

What causes creeping eruption?

Creeping eruption is caused by hookworms. Hookworm eggs are found in the infected stool (feces) of dogs and cats. After the eggs hatch, they mature into worms. The infection can be spread to people from skin contact with the worms in the stool. Hookworms may be found in moist, sandy areas. Walking barefoot on contaminated grounds in warm climates is how most people get this condition. 

What are the symptoms of creeping eruption?

The rash often shows up 1 to 5 days after you have been exposed to the hookworms. But sometimes it can take more than a month to show up. Each person may have slightly different symptoms. Symptoms may include:

• Winding, snakelike rash (because the hookworm burrows along a path that creates a winding rash)

• Itching

• Blisters

These symptoms may also be caused other skin conditions. Always see your healthcare provider for a diagnosis.

How is creeping eruption diagnosed?

Your healthcare provider will often make the diagnosis based on your health history and a physical exam.

How is creeping eruption treated?

Creeping eruption may be treated with antiparasitic medicines (such as albendazole, ivermectin, and thiabendazole). They may be taken by mouth (orally). Or they may be applied as a topical cream used directly on the rash. This condition goes away on its own, because the hookworm can't survive in human skin for very long. It will disappear in a few weeks or months even if not treated.

Can creeping eruption be prevented?

People are rarely exposed to hookworms in the U.S. This is because most cats and dogs are treated for worms. Public areas are also kept clean. Infection is more likely in tropical and semitropical countries. Most cases are reported in people who have traveled to the Caribbean, Africa, Asia, and South America. Since the hookworm larvae often enter the body through bare feet, wearing shoes will help stop infection.

Key points about creeping eruption

• Creeping eruption is a skin infection caused by hookworms.

• It can be caused by exposure to moist sand that has been contaminated by infected dog or cat stool.

• It appears as a winding, snakelike rash with blisters and itching.

• It may be treated with antiparasitic medicines.

• It is not common in the U.S. It affects travelers to the Caribbean, Africa, Asia, and South America.

• Wearing shoes will help prevent infection.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.