232 ) A 32 year old man is evaluated in the clinic for an intensely itchy rash on his feet. He denies any fever or using any recent medications. He just returned yesterday from a pleasure trip to Philippines. While on vacation , he spent his time visiting historical sites, rivers and beaches. He does not swim but enjoys walking in the water near shore. On examination, there are multiple papules on the plantar and dorsal aspect of the feet bilaterally. There are no vesicles or pustules. The skin above the level of calves is not involved. Which of the following is the most likely diagnosis?
A) Hot tub folliculitis
B) Vibrio Vulnificus
C) Cutaneous Larva Migrans
D) Swimmer’s itch
E) Strongyloidiasis
Filed under: USMLE Test Prep | Tagged: Archer Infectious Diseases, archer travel medicine, itchy traveler, travel medicine, USMLE STEP 3 DERMATOLOGY, usmle step 3 travel medicine |
Archer USMLE Step 3 Blog 
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The technical name for swimmer’s itch is cercarial dermatitis. In developing countries, swimmer’s itch translates into “rice paddy itch”, “clam diggers itch”, “sawah” to the rice farmers in Malaysia, “kubure” or “kobanyo” to the Japanese rice farmers or “hoi con” to Thai rice farmers. In these same places, all swimmers are usually exposed to the risk of cercarial dermatitis as well. On costal New Jersey, it is called “Duckworms”.
What is swimmer’s itch?
Swimmer’s itch is a patchy red pinpoint skin rash associated with itching on the parts of the body that have been in the water. Swimmer’s itch is usually not severe. After the initial transient itching it will disappear without treatment. The itching occurs within 48 hours and may last up to 7 days. Rarely, it can be severe if a large proportion of the body is affected. The major, although not the only, cause of swimmer’s itch are trematode parasites of aquatic/migrating birds. The life cycles of these parasites involve snails as the first host and aquatic birds or some mammals as the final host.
The larval parasite called a “cercaria” is released by aquatic or amphibious (moves both on land and water) snails and causes dermatitis when it mistakenly penetrates a person’s skin rather than it rightful host, usually a duck. Swimmer’s itch occurs in both freshwater and in the marine coastal environments.
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