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Hookworm folliculitis is an atypical manifestation of cutaneous larva migrans (CLM) syndrome with which dermatologists should be familiar given the increase in travel to tropical and subtropical countries, where this entity is endemic. We present a case that was diagnosed in our hospital based on the patient’s clinical history and responded favorably to treatment after other more common potential etiologies were ruled out. A 33-year-old woman in good general health with no preexisting lesions was seen for lesions on the buttocks with associated, predominantly nocturnal pruritus. The lesions had appeared 1 month earlier after a trip to Argentina and Brazil. She had received treatment at another care facility with oral corticosteroids, amoxicillin-clavulanic acid, and betamethasone-gentamicin cream, without improvement. Physical examination revealed multiple erythematous papular lesions on the buttocks, some of which were excoriated (Fig. 1). The inguinal lymph nodes were not enlarged. On suspicion of possible infectious folliculitis, a sample was taken for a herpes polymerase chain reaction test, biopsy, and laboratory tests, including serology for human immunodeficiency and hepatitis B and C viruses. The patient was prescribed valacyclovir (500 mg/12 h) for 5 days, fluconazole (50 mg/d), topical fusidic acid, and bilastine. After 5 days the lesions had worsened, and a new lesion, suggestive of a serpiginous track, had appeared. While this new lesion could have developed secondary to scratching, its appearance raised clinical suspicion of CLM (Fig. 2). Histological findings supported the clinical suspicion, showing dermal edema together with a perivascular and periadnexal inflammatory infiltrate with abundant eosinophils and perifolliculitis, without destruction of the follicular epithelium.

Foliculitis por larvas de nematodo: una infrecuente causa de foliculitis en viajeros