Conditions
Cutaneous larva migrans: an itchy red line after the beach
Cutaneous larva migrans is a skin infection caused by dog and cat hookworm larvae that get into the skin when you walk barefoot on contaminated sand or soil. It leaves a red, wavy line that itches intensely and moves a few centimeters a day, usually on the feet. The doctor can recognize it by video and, if appropriate, prescribes an antiparasitic medicine.
Is it an emergency? Call 911.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Fever with redness that is spreading, hot and painful
- Red streaks running up the leg from the rash
- Trouble breathing or facial swelling after taking a medicine
Help lines
At a glance
Cutaneous larva migrans
Common symptoms
- A thin, red, wavy line under the skin
- Very intense itching
- The line moves or changes place over the days
- Sometimes blisters form along the line
- Other names
- Creeping eruption · Hookworm rash
- Treatment
- Antiparasitic medicine, only when the medical evaluation calls for it
On this page(9)
What is cutaneous larva migrans?
Cutaneous larva migrans is caused by hookworms (Ancylostoma) that normally live in dogs and cats. Their eggs pass in the animals' feces and, in sand or soil, become larvae that can get through the skin when someone walks barefoot or lies on the sand. According to the Merck Manual, it occurs worldwide but is most common in tropical areas.
In people, the larva cannot complete its life cycle: it stays in the skin, moves under it and eventually dies. That is why it is not serious, even though the itch can be intense. It does not spread from person to person.
How we help by video
You see Dr. Diana Nieves Castro, a Puerto Rico–licensed general practice physician with several years of emergency-department experience, in English or Spanish. The diagnosis is made from how the rash looks and recent contact with sand or soil: the CDC notes there are no blood tests for this infection. The doctor checks it on camera and, if she asks, you can send photos through the secure link.
We evaluate, diagnose and treat. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. If you are pregnant or breastfeeding, tell the doctor: it changes which treatment is safe for you.
On vacation on the island? We see you too: see care for visitors. We see children of all ages, with a parent or legal guardian on camera with ID.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Your visit in 3 steps
Request a visit online 24/7 — we confirm your time by email or text.
Request your visit.
Book a visit and choose "Doctor visit". You pay by card when you request it.
See the doctor by video.
We send you a secure video link. It works on your phone, tablet or computer.
Get your plan.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
What the visit costs
Cutaneous larva migrans is handled in a US$79 doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can't take place. The pharmacy charges separately. See prices.
Cutaneous larva migrans symptoms
It starts where the larva entered, usually the feet, legs, buttocks or back. The CDC describes tracks that can move up to a few centimeters a day.
- A thin, red, wavy line under the skin
- Very intense itching
- The line moves or changes place over the days
- Sometimes blisters form along the line
Cutaneous larva migrans treatment
Without treatment it goes away on its own, but that can take weeks to months, with a lot of itching. That is why it is usually treated. According to the Merck Manual and the AAP, treatment is an antiparasitic medicine by mouth, such as albendazole or ivermectin, or in some cases a cream. The doctor chooses the right one for you, if appropriate.
Do not scratch or try to dig the larva out: it does not work and can infect the skin. If the area gets very red, hot, swollen or has pus, it may be a skin infection.
How to prevent it at the beach
The larvae enter through skin that touches sand or soil contaminated with dog or cat feces:
- Wear sandals or shoes on the sand and on soil where dogs or cats roam.
- Lie on a towel or chair, not directly on the sand.
When to get in-person care or go to the ER
Cutaneous larva migrans is not an emergency. For your safety, get in-person care or call 911 if you notice:
- Fever with redness that is spreading, hot and painful
- Red streaks running up the leg from the rash
- Trouble breathing or facial swelling after taking a medicine
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
What is the itchy red line on my foot after the beach?
Does cutaneous larva migrans go away on its own?
Is it contagious?
Can I be seen while on vacation in Puerto Rico?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-02
Sources (3)
- Zoonotic hookworm (CDC DPDx) (opens in a new tab) (accessed 2026-10-02)
- Cutaneous larva migrans (Merck Manual) (opens in a new tab) (accessed 2026-10-02)
- 12 Common Summertime Skin Rashes in Children (AAP, HealthyChildren.org) (opens in a new tab) (accessed 2026-10-02)