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Skin conditions II: parasites: medical advice from Jason Gibbs, head pharmacist at Nomad Travel stores and health clinics.

There are numerous different types of skin condition and many different causes. Here we look at common infections caused by parasites.

Creeping eruption: Otherwise known as cutaneous larvae migrans, creeping eruption is caused by a type of hookworm that is usually found in dogs. Hookworm eggs are excreted by dogs in their faeces, and humans and other hosts pick up the worm through contact with contaminated soil, often on sandy beaches. Once the hookworm has entered the skin, it causes an intense and itchy inflammatory response that looks like a piece of cooked spaghetti, caused by the worm's movement just under the surface of the skin. It's most commonly found in areas with a warm climate, such as the Caribbean, Africa and Southeast Asia, as well as parts of the USA. The condition can be treated with thiabendazole drugs or cream from a doctor

Bot and tambu flies: Found in tropical Africa and South America, bot and tambu flies have parasitic larvae that grow in mammal hosts. They usually deposit their eggs directly on a host or, in the case of people, on their clothes. Body heat induces the eggs to hatch, and the newborn larvae burrow into the skin. They are completely harmless unless a secondary infection gets into the burrow, or the burrow is in a particularly vulnerable area. They can be quite painful and often look like a boil--the larva's breathing tube poking through the tip of the boil is all that gives it away. The larva is traditionally removed by placing a piece of bacon over the breathing hole, but Vaseline or a clear non-permeable dressing does just as well. Lacking oxygen, the larva will loosen itself from its burrow and comes to the surface, from where it can much more easily be removed.

Chigger flea: This burrowing flea is usually found in tropical jungle areas and will commonly infect the skin between the toes, where it burrows and lays eggs, creating a hard, pea sized lump. This can be removed using a pin, but if the egg sac is ruptured, it can lead to re-infection from chigger fleas or bacteria.

Buruli ulcer: This condition isn't strictly parasitic, but is becoming more and more common. Buruli ulcer is a tropical disease caused by bacteria caught from direct contact with contaminated soil. The condition occurs mainly in western Africa, but is also found in Australia. The resultant ulcer can be deep and severely disfiguring and the only effective treatment is surgical intervention.

If one single piece of advice can sum up the best way of preventing these conditions it's this: wear your boots at all times. Sandals and flip-flops may be comfortable, but they offer little or no protection against disease and parasites.

* Nomad offers a travel-health consultancy service, with three clinics in London and one in Bristol You can also get advice during office hours by calling 0906 863 3414 (60p per minute) or visiting

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Title Annotation:Travel health
Geographic Code:60AFR
Date:Oct 1, 2006
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