THE CREEPING TERROR OF CUTANEOUS LARVAE

They’re way more common than you think 

“After parasitic larvae lay their eggs in human skin, a survivor and her dermatologist must stop the infestation before the worms create a breeding ground for the next generation of horrors.” Far from being the logline to a scary movie, this is the nightmare a couple of our patients have been facing recently. 

Both cases of cutaneous larva migrans (CLM), a skin condition caused by the larvae of certain parasitic hookworms — most commonly the Ancylostoma species usually found in dogs and cats — began soon after the patients had visited two popular local beaches. CLM is most common in tropical regions like the Caribbean, since the climate is favourable for breeding. 

We deduced that by doing something completely regular, like walking barefoot in the sand or sitting directly on the beach without a towel, both patients unwittingly came into contact with the parasite, likely left behind by stray animals. (That’s not the worst part!) These hookworms then burrowed under the patients’ skin and laid their eggs, effectively making their bodies a breeding ground. 

Soon, our patients noticed redness and inflammation, complete with the telltale sign of CLM’s raised, winding lesions on their skin. The horror story gets worse: the larvae move beneath the skin, leaving tracks as they go and causing intense itching and swelling. The longer the condition goes undiagnosed, the higher the risk of secondary, bacterial infections taking hold as a result of scratching. 

Just as irritating is that the condition can last for weeks — and while it’s rarely life-threatening, it can cause significant discomfort and potential complications if left untreated. Don’t think the larvae can only enter through cuts, scratches or otherwise broken skin, either — they are perfectly capable of breaking through healthy skin.

Avoiding infection  

Beaches are not the only places that pose a risk of CLM contamination. Anywhere animals are allowed to roam freely, including in playgrounds and public parks — even your own garden — can potentially be favourable breeding grounds for the larvae. One of the worst cases we’ve ever seen was on the torso, caused by a patient doing some work under this house while bare backed.

Here are a few ways to keep yourself safe from this menace: 

• Protect your feet by wearing slippers, sandals or shoes

• Be conscious of where you put your hands

• Pick up your pets' poop before it has time to fester, and dispose of it carefully

• Deworm your pets regularly 

• Avoid sitting directly on the ground, especially in public spaces; use a mat or towel as a barrier

Treatment 

Of course, sometimes these things still happen, despite taking reasonable precautions. That’s where we come in. Depending on the patient and the level of infection, we can prescribe anything from topical anti-parasitic creams (early stage) to oral medications (more advanced), both highly effective at eliminating the hookworms.  

In terms of symptom relief, we usually recommend antihistamines or corticosteroid creams to reduce inflammation and irritation. The trick is coming to see us early. If symptoms do appear, tackling the infection in its preliminary stages can provide swift relief and get you back to normal faster.

BENEATH THE SURFACE

The scary truth about melanoma in hair and nails

WARNING: This post contains an image of advanced melanoma, which may be disturbing to sensitive readers. It is shared here with our patient’s kind permission, in order to help raise awareness. 

Melanoma is not the most common of skin cancers, but it tends to be an aggressive type that can spread to other parts of the body not caught early. They’re very surreptitious, lurking in places you’d never think about — moles you may have on your body, under your hair or nails, or even on the soles of your feet. 

This form of skin cancer develops in the melanocytes, the cells responsible for producing melanin, the pigment that gives skin its colour. While the perception is that skin cancer on the whole is associated with sun-exposure, the reality is that melanomas in particular can develop in places that the sun barely touches, making them potentially more dangerous as they’re often detected late. 

Melanoma image used with patient’s permission

One patient actually had the condition misdiagnosed by a general practitioner, who deemed the dark spot on the sole of her foot a wart, and treated it as such.  so if you have concerns about anything on your skin, it’s really best to come straight to a dermatologist — this increases the likelihood of early intervention and treatment.

Scalp melanomas occur on the head, often hidden beneath the hair and therefore more difficult to spot. People with fair skin and light hair tend to be more at risk, especially if they have had a history of sunburn. They are also more common in older adults and usually take the form of: 

• An unusual mole or spot on the scalp that may be irregular in shape or colour

• A patch of skin that feels tender or itchy

• A sore that doesn’t heal or continues to bleed

We therefore recommend regular checks and professional scalp exams, especially if you fall into the higher risk category.

Subungual melanomas affect the nail bed and can show up under the nails of both fingers and toes. Such cancers are rare, but can be aggressive. People who are 50+, as well as those with darker skin tones, may be at higher risk for this type of cancer. Previous trauma to the nail can increase the risk. Patients usually notice: 

• Dark streaks — usually brown or black — under the nail that do not grow out

• A new spot or band of pigment on or around the nail

• Brittle nails start separating from the nail bed

• Pain, tenderness, or swelling in the affected area

Because these melanomas present in much the same way that final infections or damaged nails might, they often go unnoticed until the disease has progressed. Remember: Any unexplained changes to your nails should be examined by a dermatologist.

Acral lentiginous melanoma (ALMs) is a rare subtype of melanomas. They tend to show up on the palms of the hands, soles of the feet, and under the nails. Though darker skin types are at higher risk, it is important for everyone to be vigilant. Most cases appear without any direct cause, but injuries to the sole of the foot may aid in predisposition. Symptoms include: 

• A dark, irregularly shaped patch or lesion on the sole of the foot

• A sore that bleeds and doesn’t heal

• Itching or pain in the affected area

• Discolouration (brown, black, or even colourless) 

Because most people do not expect skin cancers to occur in parts of the body that are not exposed to sunlight, this type of melanoma can often be mistaken for blisters or warts — but they grow deep into tissue and can spread quickly.

Protect yourself

Melanomas often behave like the bogey-man of skin cancers, but there are ways to protect yourself: 

• Be vigilant — Conduct regular self-examinations, and check your scalp, nails, and soles regularly for any new or changing spots, lesions, or discolouration. 

• Go pro — Dermatologists can examine hard-to-see areas and provide expert evaluations of any suspicious changes.

• Screen from the sun — While melanoma in these areas is not always linked to UV exposure, protecting your skin from the sun is essential in reducing your risk.

• Play it safe — If you notice persistent changes in your nails, scalp, or feet that don’t improve, come in and see us as soon as possible, as early detection greatly improves outcomes.

Remember, regular skin checks by both you and your dermatologist are key to maintaining your skin health.

SEE US ON SATURDAYS /

We’re here to support you and your skin!

Now, to help avoid time lost at school or work, we’re accommodating dermatological appointments on Saturdays, starting at 9:00 a.m. and finishing at noon.

We look forward to seeing you at a time that suits your schedule.

IS YOUR TEEN’S SKIN READY FOR BACK-TO-SCHOOL?

“Anxiety-provoked skin conditions require a holistic approach.”

— Dr. Tonya Abraham-Ali

As the July/August vacation comes to a close, the excitement — and uncertainties — of a new academic year can be overshadowed by anxiety. The first place this shows up is the skin, which causes even more emotional distress and perpetuates the whole vicious cycle.  Here’s how to help your children through it…

How anxiety affects the skin 

Skin conditions that are worsened by anxiety are a visible reminder of the mind/body connection. A powerful emotion that can wreak havoc on both mental and physical health by triggering the release of stress hormones like cortisol and adrenaline, anxiety creates a “fight or flight” response in the body. This hormonal imbalance can disrupt normal skin function, leading to or worsening skin conditions.

Conditions to look for…

• Acne

A common skin condition among teens, acne tends to worsen with stress. Increased anxiety triggers the production of cortisol, a hormone that can lead to excess oil production and inflammation, resulting in more breakouts. Because acne is so noticeable, it can cause embarrassment, creating a seemingly never-ending loop. 

• Eczema

Eczema is a chronic condition that causes dry, itchy, inflamed skin. Anxiety makes flare-ups not just worse, but also more frequent. It’s uncomfortable and near impossible to resist scratching, which in turn can lead to skin infections. 

• Hives

Anxiety can also cause hives — those rash-like, itchy welts that suddenly appear on skin. Stress-induced hives are usually the result of the body releasing histamines (chemicals that cause an allergic reaction) in response to anxiety.

• Psoriasis

An autoimmune condition that causes rapid skin cell turnover, psoriasis causes red, scaly patches to appear on the skin. Anxiety can both trigger and worsen flare-ups, causing inflammation and weakening the immune system. 

• Skin Picking

Some teens, when they’re anxious, develop a habit of picking at their skin as a coping mechanism. This can lead to open sores, scarring, and infections.

How to tackle them

• Watch the routine

A simple skincare routine is great for managing conditions like acne and eczema, but consistency is key.  

— For acne, use non-comedogenic products and avoid harsh scrubs

— For eczema, moisturise regularly and use fragrance-free products

— For hives, use gentle, fragrance-free soap and cleanser

— For psoriasis, choose gentle cleansers and moisture-rich soaps; when moisturising, opt for creams, oils or ointments as opposed to lotions

— For skin picking, talk to your dermatologist who may recommend trusted approaches/support to stop the habit, in conjunction with treatments that may include antioxidants, chemical peels, and brightening serums

• Change the behaviour 

 For those struggling with skin picking in particular, interventions like cognitive behavioural therapy and habit reversal training can help break the cycle. 

• Manage stress 

Tried and true techniques like deep breathing, mindfulness, physical exercise and proper sleep routines can reduce anxiety minimise anxiety-related skin conditions.

• Nurture your relationship

Creating a supportive home environment where teens can talk about their concerns goes a long way to calming them down and reducing their anxiety. 

• Get the right help 

If anxiety (and the resulting skin conditions) become severe, professional advice from a dermatologist or a mental health professional is important. They can provide and/or recommend specialised treatments, therapies, and medications to address both the skin condition and the anxiety behind it. 

This way, your teens can start the school year feeling more confident and comfortable in their skin.

THE MIND/BODY CONNECTION

“Neuropsychology and dermatology definitely intersect.”

— Dr. Tonya Abraham-Ali

The connection between the mind and skin is a fascinating field that sits at the crossroads of neuropsychology and dermatology. It primarily manifests through psychodermatological disorders — conditions where psychological factors profoundly affect skin health. 

One of the most intriguing and challenging of these is delusions of parasitosis, where people falsely believe their skin is infested with parasites, leading to significant distress and often self-inflicted skin damage.

Despite the fact that there is no medical evidence supporting this belief, patients say they feeling crawling, biting, or stinging sensations on their skin, which they attribute to imagined insects, worms, etc. As a result, they often engage in compulsive behaviours like scratching, washing, or applying harmful products in an attempt to rid themselves of the perceived infestation. Naturally, this can lead to significant skin damage, infections, and scarring.

The condition is classified as a somatic delusion, where psychological distress manifests as a physical complaint, making it challenging to manage. Addressing these types of conditions therefore requires a multidisciplinary approach, often combining dermatological care with mental health treatments. 

Antipsychotic medications are often the cornerstone of treatment. They work by targeting dopamine receptors in the brain, helping to alleviate delusional thinking and reduce compulsive behaviours. 

Patients tend to resist at first, as they believe their condition to be purely physical, but with empathetic communication and strong support — including cognitive behavioural therapy — this approach can lead to significant improvement. It’s always inspirational to see patients develop healthier coping mechanisms and reduce the anxiety level regarding their skin sensations.

By combining dermatological expertise with awareness about the role mental health plays, conditions like these can be overcome, improving the imagined symptoms and greatly enhancing quality of life.