A Case of the Creeping Crud
If you have been around medicine long enough and seen enough patients with rashes then you have probably heard the term "creeping crud." It is often used by older patients to describe a rash that appears to be spreading or moving to other areas of the body. In most cases, these rashes are not actually creeping or moving. They are one of the various subtypes of eczema, a newly diagnosed psoriasis, pityriasis rosea or tinea.
The creeping crud does have a foundation in dermatology and refers to a specific parasitic infestation. The correct medical diagnosis is cutaneous larva migrans or creeping eruption. It is caused by the hook worm larvae aimlessly wandering under the skin (figure 1 and 2 below).
It is common in warm climates and amongst people who garden or work in environments where animals, most commonly cats, dogs or raccoons can get, such as under trailers or elevated homes. The eggs are in the fecal matter of these animals and when they hatch they lie in wait for a warm blooded animal to infest and mature.
Figure 1 (above)
Figure 2 (above)
Luckily this condition is easily treated with Albendazole 200mg twice daily for 3 days. The larvae die and the trails left by the infestation will flatten and slowly fade away (figures 3 and 4). So the next time a patient comes to see you and says they have the creeping crud you can assure them that they do not, or if they do you, now know how to cure it.
Figure 3 (above)
Figure 4 (above)