Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Skin lesions in the returning traveler

Mary Elizabeth Wilson, MD
Section Editor
Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
Deputy Editor
Elinor L Baron, MD, DTMH


Skin lesions are a common reason for returned travelers to seek medical evaluation (table 1). Among more than 17,000 ill returned travelers evaluated at one of the 30 GeoSentinel travel clinics worldwide, dermatologic disorders were the third most common problem (after systemic febrile illness and acute diarrhea) [1]. In another study of GeoSentinel network data including more than 25,000 patients evaluated following travel, a skin-related diagnosis was reported in 18 percent of patients [2].

The causes, manifestations, and diagnosis of skin lesions in the returned traveler will be reviewed here [3].


The differential diagnosis for skin lesions that occur during or after travel is broad and includes infections due to pathogenic organisms (viruses, bacteria, fungi, helminths, protozoa), arthropod bites and infestations, allergic and hypersensitivity reactions [4], injury by chemicals and ultraviolet light, and trauma [5,6]. Among 269 patients in France with travel-associated skin problems, the most common diagnoses were [7]:

Cutaneous larva migrans – 25 percent

Pyoderma – 18 percent

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 19, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 2006; 354:119.
  2. Lederman ER, Weld LH, Elyazar IR, et al. Dermatologic conditions of the ill returned traveler: an analysis from the GeoSentinel Surveillance Network. Int J Infect Dis 2008; 12:593.
  3. Ryan ET, Wilson ME, Kain KC. Illness after international travel. N Engl J Med 2002; 347:505.
  4. Dromgoole SH, Maibach HI. Sunscreening agent intolerance: contact and photocontact sensitization and contact urticaria. J Am Acad Dermatol 1990; 22:1068.
  5. Wilson ME. A world guide to infections: Diseases, distribution, diagnosis, Oxford University Press, New York 1991.
  6. Wilson ME. Skin problems in the traveler. Infect Dis Clin North Am 1998; 12:471.
  7. Caumes E, Carrière J, Guermonprez G, et al. Dermatoses associated with travel to tropical countries: a prospective study of the diagnosis and management of 269 patients presenting to a tropical disease unit. Clin Infect Dis 1995; 20:542.
  8. Lucchina LC, Wilson ME, Drake LA. Dermatology and the recently returned traveler: infectious diseases with dermatologic manifestations. Int J Dermatol 1997; 36:167.
  9. Larson JL, Clark RF. Plant Toxins in the Tropics. In: Tropical Infectious Diseases: Principles, Pathogens and Practice, Guerrant RL, Walker DH, Weller PF (Eds), Elsevier, Philadelphia 2005. p.102.
  10. Marcos LA, Kahler R. Phytophotodermatitis. Int J Infect Dis 2015; 38:7.
  11. Hochedez P, Canestri A, Guihot A, et al. Management of travelers with fever and exanthema, notably dengue and chikungunya infections. Am J Trop Med Hyg 2008; 78:710.
  12. Wilder-Smith A, Schwartz E. Dengue in travelers. N Engl J Med 2005; 353:924.
  13. Simmons CP, Farrar JJ, Nguyen vV, Wills B. Dengue. N Engl J Med 2012; 366:1423.
  14. Taubitz W, Cramer JP, Kapaun A, et al. Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis 2007; 45:e1.
  15. Borgherini G, Poubeau P, Staikowsky F, et al. Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients. Clin Infect Dis 2007; 44:1401.
  16. Cordel N, Birembaux X, Chaumont H, et al. Main Characteristics of Zika Virus Exanthema in Guadeloupe. JAMA Dermatol 2017; 153:326.
  17. Waggoner JJ, Gresh L, Vargas MJ, et al. Viremia and Clinical Presentation in Nicaraguan Patients Infected With Zika Virus, Chikungunya Virus, and Dengue Virus. Clin Infect Dis 2016; 63:1584.
  18. Marschang A, Nothdurft HD, Kumlien S, von Sonnenburg F. Imported rickettsioses in German travelers. Infection 1995; 23:94.
  19. Walker DH. Rickettsioses of the spotted fever group around the world. J Dermatol 1989; 16:169.
  20. Walker DH, Dumler JS. Emerging and reemerging rickettsial diseases. N Engl J Med 1994; 331:1651.
  21. Jensenius M, Fournier PE, Vene S, et al. African tick bite fever in travelers to rural sub-Equatorial Africa. Clin Infect Dis 2003; 36:1411.
  22. Parola P, Paddock CD, Socolovschi C, et al. Update on tick-borne rickettsioses around the world: a geographic approach. Clin Microbiol Rev 2013; 26:657.
  23. Kemper CA, Spivack AP, Deresinski SC. Atypical papulovesicular rash due to infection with Rickettsia conorii. Clin Infect Dis 1992; 15:591.
  24. Kass EM, Szaniawski WK, Levy H, et al. Rickettsialpox in a New York City hospital, 1980 to 1989. N Engl J Med 1994; 331:1612.
  25. Hudson BJ, McPetrie R, Kitchener-Smith J, Eccles J. Vesicular rash associated with infection due to Rickettsia australis. Clin Infect Dis 1994; 18:118.
  26. Park J, Woo SH, Lee CS. Evolution of Eschar in Scrub Typhus. Am J Trop Med Hyg 2016; 95:1223.
  27. Raoult D, Fournier PE, Fenollar F, et al. Rickettsia africae, a tick-borne pathogen in travelers to sub-Saharan Africa. N Engl J Med 2001; 344:1504.
  28. Ripamonti D, Massari M, Arici C, et al. African sleeping sickness in tourists returning from Tanzania: the first 2 Italian cases from a small outbreak among European travelers. Clin Infect Dis 2002; 34:E18.
  29. Jelinek T, Bisoffi Z, Bonazzi L, et al. Cluster of African trypanosomiasis in travelers to Tanzanian national parks. Emerg Infect Dis 2002; 8:634.
  30. Iborra C, Danis M, Bricaire F, Caumes E. A traveler returning from Central Africa with fever and a skin lesion. Clin Infect Dis 1999; 28:679.
  31. McGovern TW, Williams W, Fitzpatrick JE, et al. Cutaneous manifestations of African trypanosomiasis. Arch Dermatol 1995; 131:1178.
  32. Cochran R, Rosen T. African trypanosomiasis in the United States. Arch Dermatol 1983; 119:670.
  33. Cairns L, Blythe D, Kao A, et al. Outbreak of coccidioidomycosis in Washington state residents returning from Mexico. Clin Infect Dis 2000; 30:61.
  34. Lapins J, Lindbäck S, Lidbrink P, et al. Mucocutaneous manifestations in 22 consecutive cases of primary HIV-1 infection. Br J Dermatol 1996; 134:257.
  35. Hoeffler DF. Cercarial dermatitis. Arch Environ Health 1974; 29:225.
  36. Centers for Disease Control (CDC). Cercarial dermatitis outbreak at a state park--Delaware, 1991. MMWR Morb Mortal Wkly Rep 1992; 41:225.
  37. Visser LG, Polderman AM, Stuiver PC. Outbreak of schistosomiasis among travelers returning from Mali, West Africa. Clin Infect Dis 1995; 20:280.
  38. Freudenthal AR, Joseph PR. Seabather's eruption. N Engl J Med 1993; 329:542.
  39. Tomchik RS, Russell MT, Szmant AM, Black NA. Clinical perspectives on seabather's eruption, also known as 'sea lice'. JAMA 1993; 269:1669.
  40. Wong DE, Meinking TL, Rosen LB, et al. Seabather's eruption. Clinical, histologic, and immunologic features. J Am Acad Dermatol 1994; 30:399.
  41. Bresson-Hadni S, Humbert P, Paintaud G, et al. Skin localization of alveolar echinococcosis of the liver. J Am Acad Dermatol 1996; 34:873.
  42. Shenefelt PD, Esperanza L, Lynn A. Elusive migratory subcutaneous dirofilariasis. J Am Acad Dermatol 1996; 35:260.
  43. Wortman PD. Subcutaneous cysticercosis. J Am Acad Dermatol 1991; 25:409.
  44. Rook A, Staughton R. The cutaneous manifestations of toxocariasis. Dermatologica 1972; 144:129.
  45. McCarthy JS, Ottesen EA, Nutman TB. Onchocerciasis in endemic and nonendemic populations: differences in clinical presentation and immunologic findings. J Infect Dis 1994; 170:736.
  46. Pryce D, Behrens R, Davidson R, et al. Onchocerciasis in members of an expedition to Cameroon: role of advice before travel and long term follow up. BMJ 1992; 304:1285.
  47. Encarnacion CF, Giordano MF, Murray HW. Onchocerciasis in New York City. The Moa-Manhattan connection. Arch Intern Med 1994; 154:1749.
  48. Davis-Reed L, Theis JH. Cutaneous schistosomiasis: report of a case and review of the literature. J Am Acad Dermatol 2000; 42:678.
  49. Matteelli A, Castelli F, Spinetti A, et al. Short report: verruga peruana in an Italian traveler from Peru. Am J Trop Med Hyg 1994; 50:143.
  50. Kostman JR, DiNubile MJ. Nodular lymphangitis: a distinctive but often unrecognized syndrome. Ann Intern Med 1993; 118:883.
  51. Davis BR. Filariases. Dermatol Clin 1989; 7:313.
  52. WARTMAN WB. Filariasis in American armed forces in World War II. Medicine (Baltimore) 1947; 26:333.
  53. van der Werf TS, van der Graaf WT, Tappero JW, Asiedu K. Mycobacterium ulcerans infection. Lancet 1999; 354:1013.
  54. Evans ME, Gregory DW, Schaffner W, McGee ZA. Tularemia: a 30-year experience with 88 cases. Medicine (Baltimore) 1985; 64:251.
  55. McGovern TW, Christopher GW, Eitzen EM. Cutaneous manifestations of biological warfare and related threat agents. Arch Dermatol 1999; 135:311.
  56. Centers for Disease Control and Prevention (CDC). Outbreak of leptospirosis among white-water rafters--Costa Rica, 1996. MMWR Morb Mortal Wkly Rep 1997; 46:577.
  57. Ko AI, Galvão Reis M, Ribeiro Dourado CM, et al. Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group. Lancet 1999; 354:820.
  58. Monsuez JJ, Kidouche R, Le Gueno B, Postic D. Leptospirosis presenting as haemorrhagic fever in visitor to Africa. Lancet 1997; 349:254.
  59. Derham RL, Owens GG, Wooldridge MA. Leptospirosis as a cause of erythema nodosum. Br Med J 1976; 2:403.
  60. Davies HD, Sakuls P, Keystone JS. Creeping eruption. A review of clinical presentation and management of 60 cases presenting to a tropical disease unit. Arch Dermatol 1993; 129:588.
  61. Jelinek T, Maiwald H, Nothdurft HD, Löscher T. Cutaneous larva migrans in travelers: synopsis of histories, symptoms, and treatment of 98 patients. Clin Infect Dis 1994; 19:1062.
  62. Tremblay A, MacLean JD, Gyorkos T, Macpherson DW. Outbreak of cutaneous larva migrans in a group of travellers. Trop Med Int Health 2000; 5:330.
  63. Ma DL, Vano-Galvan S. IMAGES IN CLINICAL MEDICINE. Creeping Eruption--Cutaneous Larva Migrans. N Engl J Med 2016; 374:e16.
  64. Richey TK, Gentry RH, Fitzpatrick JE, Morgan AM. Persistent cutaneous larva migrans due to Ancylostoma species. South Med J 1996; 89:609.
  65. Caumes E, Carriere J, Datry A, et al. A randomized trial of ivermectin versus albendazole for the treatment of cutaneous larva migrans. Am J Trop Med Hyg 1993; 49:641.
  66. ARTHUR RP, SHELLEY WB. Larva currens; a distinctive variant of cutaneous larva migrans due to Strongyloides stercoralis. AMA Arch Derm 1958; 78:186.
  67. von Kuster LC, Genta RM. Cutaneous manifestations of strongyloidiasis. Arch Dermatol 1988; 124:1826.
  68. Rusnak JM, Lucey DR. Clinical gnathostomiasis: case report and review of the English-language literature. Clin Infect Dis 1993; 16:33.
  69. Crowley JJ, Kim YH. Cutaneous gnathostomiasis. J Am Acad Dermatol 1995; 33:825.
  70. Diaz Camacho SP, Zazueta Ramos M, Ponce Torrecillas E, et al. Clinical manifestations and immunodiagnosis of gnathostomiasis in Culiacan, Mexico. Am J Trop Med Hyg 1998; 59:908.
  71. Nutman TB, Miller KD, Mulligan M, Ottesen EA. Loa loa infection in temporary residents of endemic regions: recognition of a hyperresponsive syndrome with characteristic clinical manifestations. J Infect Dis 1986; 154:10.
  72. Klion AD, Massougbodji A, Sadeler BC, et al. Loiasis in endemic and nonendemic populations: immunologically mediated differences in clinical presentation. J Infect Dis 1991; 163:1318.
  73. Rakita RM, White AC Jr, Kielhofner MA. Loa loa infection as a cause of migratory angioedema: report of three cases from the Texas Medical Center. Clin Infect Dis 1993; 17:691.
  74. Kazura JW. Tissue nematodes, including trichinellosos, dracunculiasis, and the filariases. In: Mandell, Douglas, and Bennett's Principles and Practices of Infectious Diseases, 7th edition, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone Elsevier, Philadelphia 2010. Vol 2, p.3587.
  75. Myers SA, Sexton DJ. Dermatologic manifestations of arthropod-borne diseases. Infect Dis Clin North Am 1994; 8:689.
  76. Brown S, Becher J, Brady W. Treatment of ectoparasitic infections: review of the English-language literature, 1982-1992. Clin Infect Dis 1995; 20 Suppl 1:S104.
  77. Arosemena R, Booth SA, Su WP. Cutaneous myiasis. J Am Acad Dermatol 1993; 28:254.
  78. Brewer TF, Wilson ME, Gonzalez E, Felsenstein D. Bacon therapy and furuncular myiasis. JAMA 1993; 270:2087.
  79. Lachish T, Marhoom E, Mumcuoglu KY, et al. Myiasis in Travelers. J Travel Med 2015; 22:232.
  80. Park JJ, Costello J. Tumbu Fly Larvae. N Engl J Med 2017; 376:e22.
  81. Boggild AK, Keystone JS, Kain KC. Furuncular myiasis: a simple and rapid method for extraction of intact Dermatobia hominis larvae. Clin Infect Dis 2002; 35:336.
  82. Sanusi ID, Brown EB, Shepard TG, Grafton WD. Tungiasis: report of one case and review of the 14 reported cases in the United States. J Am Acad Dermatol 1989; 20:941.
  83. Matono T, Kato Y, Yotsu R, Ohmagari N. Tungiasis: diagnosis at a glance. Lancet 2016; 388:275.