2 Berman A, Winkelmann RK. Seborrheic keratoses:

Appearance in course of exfoliative erythroderma and

regression associated with histologic mononuclear cell

inflammation. Arch Dermatol 1982; 118: 615–8.

3 Schwengle LEM, Rampen FHJ. Eruptive seborrheic keratoses

associated with erythrodermic pityriasis rubra pilaris. Acta

Derm Venereol (Stockh) 1988; 68: 443–5.

4 Flugman SL, McLain SA, Clark RAF. Transient eruptive

seborrheic keratoses associated with erythrodermic psori-

asis and erythrodermic drug eruption: Report of two cases.

J Am Acad Dermatol 2001; 45: S212–S14.

5 Barriere H, Litoux P, Bureau B, Welin J. Acanthomes post-

eczema. Bull Soc Fr Dermatol Syphil 1972; 79: 555–7.

6 Satterfield PA, Haas AF. Postoperative localized eruption of

seborrheic keratoses. J Am Acad Dermatol 1998; 38: 267–8.

7 Schumacher A, Stuttgen G. Vitamin-A-Saure bei Hyper-

keratosen, epithelialen Tumoren und Akne. Dtsch Med

Wochenschr 1971; 96: 1547–51.

Cutaneous larva migrans acquired in Britain

Cases of cutaneous larva migrans acquired in the northernhemisphere, with no history of travel abroad are increas-ingly reported. Our patient was a 50-year-old man whopresented with a rash after paint-balling 3 weeks previ-ously during the month of October. Paint-balling is anoutdoor activity, carried out in this instance, in a NorthLondon wooded area. He had been wearing stiff armyfatigues which covered the whole skin as they tucked intohis gloves. These clothes were stored, after washing, in ahut in a wood in which a dog was also kept.

Eight days later, there were approximately 40 lesionsthat looked like bite marks on the medial surface of his leftforearm and his abdomen. He then noticed multiple itchythread-like eruptions emanating from the marks, whichalso seemed to have shifted location. There was no recenthistory of travel abroad, though he had travelled to SriLanka 3 years previously. He reported that a friend had asimilar rash following the paint-balling activity, but thefriend was not examined by the authors.

On examination, he had thin serpiginous raised tracksover his abdomen, chest, and left forearm, in keeping witha diagnosis of cutaneous larva migrans (CLM) (Fig. 1).A skin biopsy taken in front of a leading edge showed achronic inflammatory infiltrate surrounding dermal bloodvessels with neutrophils marginating within blood vesselsbut no evidence of hookworm infestation was seen. He wastreated with topical Dermovate� and then received oralalbendazole 400 mg twice a day for 5 days and madea good recovery.

CLM is caused by larva of certain nematode wormspenetrating the human skin. These larvae are found in soilcontaminated with the faeces of cats and dogs infected withhookworms such as Ancylostoma and Uncinaria. CLM iscommonly seen in the Caribbean, Africa, South Americaand the Gulf1 and in travellers from these areas.

High temperatures and humidity usually allow thelarvae to develop from the eggs.2 One case report fromGermany3 was explained by an unusually warm andhumid summer at the time when the patient presented.However, there have been two recent case reports fromBritain, one from the south of England during the autumnmonth of September4 and the other from the west ofScotland5 where temperatures are cooler. Our patientpresented in October when the temperature was neitherhot nor humid. It is seems most likely that the clothes wereindirectly infected from dog or cat faeces, either in the hutor elsewhere. If protected from sunlight larvae can surviveand develop dry fomites for extended periods in store sheds,even in Europe.6 Abrasion with the infected material aidslarval penetration.

CLM contracted in the northern hemisphere remains anuncommon diagnosis, though it appears to be increasinglyreported. Keeping cats and dogs in close proximity toclothes should be discouraged.

V. C. Diba, C. J. M. Whitty* and T. Green†

Department of Dermatology, Addenbrooke’s Hospital, Cambridge,

*Hospital for Tropical Diseases, London, and

†Department of Dermatology, Lister Hospital, Stevenage, UK

Accepted for publication 16 March 2004

References

1 Herbener D, Borak J. Cutaneous larva migrans in northern

climates. Am J Emerg Med 1988; 6: 462–4.

2 Albanese G, Di Cintio R, Beneggi M et al. Larva migrans in

Italy. Int J Dermat 1995; 34: 464–5.

3 Klose C, Mravak S, Geb M et al. Autochthonous cutaneous

larva migrans in Germany. Trop. Med Int Health 1996;

1: 503–4.

4 Roest M. Ratnavel R. Cutaneous larva migrans contracted in

England: a reminder. Clin Exp Dermatol 2001; 26: 389–90.

5 Beattie PE, Fleming CJ. Cutaneous larva migrans in the

west coast of Scotland. Clin Exp Dermat 2002; 27: 248–9.

Figure 1 Serpiginous lesions of CLM.

Correspondence

� 2004 Blackwell Publishing Ltd • Clinical and Experimental Dermatology, 29, 545–562 555

6 Galanti B, Frusco FM, Nardiello S. Outbreak of cutaneous

larva migrans in Naples, southern Italy. Trans Royal Soc

Trop Med Hyg 2002; 96: 491–2.

Segmental neurofibromatosis on the face

A 22-year-old man presented with multiple small-elevatedlesions over his nose which had developed progressivelyover the past 16 years. On examination, discrete andcoalescing pink and shiny coloured papulonodular lesions(0.5 · 1cm) distributed over the left side of his noseincluding the vestibule and adjacent parts of the cheekalong the distribution of the maxillary division of the fifthcranial nerve (Fig. 1). On palpation, lesions were mostlysoft in consistency and nontender. There were no telan-giectasia, ulceration or other surface change. No otherabnormalities were detected on the rest of his body. Onfurther questioning, the patient denied any history ofsystemic disease or similar disease in the family. His generalphysical examination was normal including stature, intel-ligence, speech, and auditory functions. Slit lamp exam-ination of the eyes and imaging of his brain did not revealany abnormality. Biopsy of a lesion showed normalepidermis, and a well defined proliferation of neural tissueincluding Schwann cells and fibroblasts in the dermisconsistent with neurofibroma (Fig. 2) and strong positivitywith S-100 protein immunostain within tumour nodules(Fig. 3).

Segmental neurofibromatosis (SN) is a rare disorder,approximately 10 times less frequent than neurofibroma-tosis 1 (NF-1). It is characterized by neurofibromas and ⁄ orcafe-au-lait macules limited to one region of the body. SNwas first described by Gammel in 1931.1 Following thisCrowe et al.2 described additional patients with neurofibro-mas and cafe-au-lait macules in a dermatomal distributionand suggested a term �sectorial neurofibromatosis�. Millerand Sparkes3 proposed the term of SN, which is still used inthe contemporary literature. According to Riccardi’s4

classification, SN is included in Type V NF that includesunilateral SN. However, many apparent cases could notfulfil these stringent criteria. Roth et al.5 further classifiedSN into four subtypes: true segmental, localized cases withdeep involvement, hereditary segmental and bilateral SN.

Figure 2 (a) Multiple nodules of spindle-shaped cells present in

the dermis. The overlying skin is unremarkable (haematoxylin

& eosin, ·140). (b) Single tumour nodule in the dermis with

spindle-shaped cells having tapering ends and kinking of the nuclei

(haematoxylin & eosin, ·550).

Figure 1 Papulonodular lesions over left side of nose and adjacent

parts of cheek.

Correspondence

556 � 2004 Blackwell Publishing Ltd • Clinical and Experimental Dermatology, 29, 545–562