Patient if Dr

I saw this 65 year old male 1 week ago with a very itchy rash on the right lower shin which he claims started after he got stung while whippersnipping long grass near his house. The rash appeared as red non scaly lesion and ? serpinginous. I thought this to be cutaneous larva migrans and gave him 12mg Ivermectin and some advantan oint to relieve the itch.I saw him again today and the rash remains very itchy and has progressed somewhat. Any ideas and suggestions welcome.

It could be a reaction to the hairs of a caterpillar or a phytophoto reaction to some sap on his skin and sunlight. I would use a strong topical steroid cream such as Diprosone BD. A biopsy would be useful but not essential.
Cutaneous larva migrans is due to a hookworm larvae insertion under the skin. It is aquired from larvae on sandy beaches rather than a risk of wippersnipping! (Submitted By: Dr Ian McColl)