What are the topical medicines for Strongyloides infestation?

Question

Hello doctor,

I am 40 years old. I have been diagnosed with illnesses such as eczema, asthma, rhinitis, CFS, IBS, and Strongyloides infestation. An infection specialist, a few months ago, diagnosed Strongyloides using two types of blood tests.

He concluded, based on what I had told him, that this has been an almost lifelong infestation ever since I visited another country as an infant. He gave Ivermectin (3 mg tablets as a single dose, thrice daily, and then repeated this in two weeks).

When I saw him again, I never felt any improvement. I felt just as ill, and the sensation of insects crawling on my skin also was/is still present.

He took some blood again for the white blood cell count. He never explained to me whether any other options were available if Ivermectin turned out to be unhelpful. My questions are:

What is the second-best drug for this condition, if Ivermectin fails?
Are there any topical medicines for this infestation to get rid of the outward symptoms?

Kindly suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

Strongyloidiasis is a parasitic infection caused by Strongyloides stercoralis, where larvae enter through the skin and infect the intestines. It can persist for years due to an internal reinfection cycle.

Strongyloidiasis is usually treated with Ivermectin, but sometimes longer or repeated courses are needed if symptoms persist. If ivermectin is not effective, the main alternative is Albendazole, though it may be slightly less effective.

Before changing treatment, it is important to confirm whether the infection is still active with repeat tests. I suggest you do serological tests to confirm that you have a Strongyloides infection. Albendazole is the next best medicine for treatment, 400 mg for three days.

But it is better to confirm before starting the treatment. The crawling skin sensation is not always due to ongoing infection and may be related to eczema, nerve sensitivity, or other conditions.

There are no topical medications that can eliminate this parasite, as it resides internally, but antihistamines or soothing creams may help relieve symptoms. A follow-up evaluation would be advisable.

I hope you find this information helpful.

For further queries and concerns, feel free to reach out to me anytime.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your concerns.

The doctor might be reluctant to give a higher dose of Ivermectin due to the reactions it can cause. If the dose is increased, the death of the parasite might be increased if the parasite load is still high.

The death of a parasite might itself lead to a hyperreactive state, which might be more dangerous. The products of the killed parasite can be acted upon by your immune system, which leads to hypersensitivity reactions.

Your concern about a positive blood test result for Strongyloides shows that the parasite is in the blood. The serological tests can confirm that you have the infection. But to confirm that the parasite is still active, it needs to be isolated from the body, stool, or urine, based on the species of Strongyloides.

I have the sensation of loads of insects moving on the skin (larva currens), which he understood. Your concern regarding these parasites carrying certain bacteria on the skin in huge numbers, causing the weeping skin infections and wounds around the body:

Yes. These parasites, because of the medicine you have taken or if they are not of the human variety, can wander in different parts of the body. A moving larva of the parasite under your skin can be the cause of larva currens. If the sensation is still there, then it means that the parasite is still active in your body.

Usually, the bacteria they carry might not cause much damage. If the immunity is low, it might cause disseminated infection in the region where they localize.

I hope your queries have been answered.

For more queries, feel free to reach out to me anytime.

Thank you.