Chief Complaint: “I have an itchy, winding rash on my foot that seems to be moving.”

History of Present Illness:
A 35-year-old man presents to the clinic with a red, intensely itchy rash on the sole of his left foot. He first noticed it five days ago after returning from a beach vacation, where he frequently walked barefoot on the sand. Initially, the rash appeared as a small red spot, but over the past few days, it has elongated and taken on a serpiginous (snake-like) pattern. He reports worsening itching, especially at night, but denies fever, swelling, or systemic symptoms.

Physical Examination:

• A raised, erythematous, serpiginous track measuring about 3 cm in length on the sole of the left foot
• No pustules, drainage, or signs of bacterial superinfection
• No lymphadenopathy or systemic symptoms

Diagnosis:
The clinical findings and history of barefoot exposure in a sandy environment strongly suggest cutaneous larva migrans (CLM), commonly known as creeping eruption. This is caused by the larvae of hookworms (e.g., Ancylostoma braziliense) that penetrate the skin but fail to mature in humans.

Management Plan:

• Antiparasitic therapy: Oral ivermectin or albendazole to eliminate the larvae
• Symptomatic relief: Topical corticosteroids and oral antihistamines to control itching
• Patient education:
  • Avoid walking barefoot in sandy or contaminated areas
  • Wash feet thoroughly after potential exposure
  • Preventive measures in high-risk areas, such as wearing protective footwear

The patient is reassured that the condition is self-limiting but can persist for weeks if untreated. A follow-up visit is scheduled to assess treatment response.