Keeping your toes in tip-top shape is key to staying pain-free. Small studies have found that after 10 days of treatment, cure rates are as high as 98 percent. Abuse may lead to moderate or low physical dependence or high psychological dependence. Host infection via inadvertent ingestion (human hookworm). Learn about its symptoms, the tape test, and effective methods of. Patel S, et al. What you should be alert for in the history. Your healthcare provider will often make the diagnosis based on your health history and a physical exam. This is because most cats and dogs are treated for worms. No matter what, try to resist the urge to scratch any itchy spots between your toes. The rash often shows up 1 to 5 days Hoboken, NJ: Wiley Blackwell. Ask about a history of close contacts with a similar acute onset of pruritus. Each person may have slightly different symptoms. Winding, snakelike rash (because the The prevalence of creeping eruption is high among the less privileged communities in these areas. Write To Dr . Before your visit, write down questions you want answered. The focus is not on curing the disease but to cure the person who is sick, to restore the health. Sharma. - Full-Length Features (2010). Healthline Media does not provide medical advice, diagnosis, or treatment. These larvae can be present in contaminated soil, sand, and wet environments, and can be spread to humans when they come into contact with the skin. Exposure and travel history is very important to obtain. However, in some cases it may take longer for the infection to go away. you. It may be treated with antiparasitic The lesion is about 23 mm wide and contains a clear serous fluid. This condition goes away on its own, because the hookworm can't survive Many things can trigger an itch between your toes. Walking barefoot on contaminated grounds in warm climates is how most people get this If you wish to read unlimited content, please log in or register below. (2017). Creeping eruption is common in tropical and subtropical geographical areas like the Southeastern United States, Caribbean islands, Africa, Central and South America and Southeast Asia. Know why a new medicine or treatment is prescribed, and how it will help you. You can sometimes figure out the most likely culprit by the size of the welt. So the common and perfect eruption cyst home remedy is:-3-step home remedy This home remedy includes three steps that provide complete relaxation for the eruption cyst. Creeping eruption causes severe itching, blisters, and a red growing, winding rash. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. If you develop a fever or hives, dont wait to seek medical care. A follow-up appointment 4 to 6 weeks after treatment would be appropriate to document clinical improvement or resolution. Treatment of signs and symptoms (Pruritus) of interdigital tinea pedis with econazole nitrate foam, 1. All rights reserved. The human hookworm, Ancylostoma duodenale, can also cause creeping eruption on the buttocks, especially in children. Infection is more likely in tropical and semitropical countries. Treatment with a single 400-mg oral dose of albendazole gives cure rates of 46%100%; a single 12-mg oral dose of ivermectin gives cure rates of 81%100%. condition. Wearing shoes will help prevent infection. The correct homeopathy remedy tries to correct this disease predisposition. What are the causes and risks of the condition? A topical analgesic such as pramoxine could be of benefit. The infection often appears on parts of the body that have been exposed to the contaminated ground. They're often found in places like the seams of your mattress or cracks in your bed frame. Know the reason for your visit and what you want to happen. Symptoms may include: Winding, snakelike rash (because the hookworm burrows along a path that creates a winding rash). All rights reserved. Sometimes, a cold compress can also bring some temporary relief. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Or they may be applied as a topical cream used directly It is a Topical treatment of the affected area with 10%15% thiabendazole solution or ointment has limited value for multiple lesions and hookworm folliculitis, and requires applications 3 times a day for at least 15 days. tropical or subtropical) climates contaminated by fecal matter. Humans are unusual Persons traveling to high-risk tropical or subtropical beaches should be encouraged to wear appropriate protective footwear or sit on towels. Who is at Risk for Developing this Disease? In creeping eruption human host is the dead end for the larva, unlike the larva currens. There have been reports of the creeping eruption appearing on the male genitalia. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, Creeping eruption is a skin infection caused by hookworms. Freezing the leading edge of the skin track rarely works. It is interesting that 3 of the 4 studies with a 100% cure rate involved inhabitants of regions of endemicity, in whom it is difficult to distinguish between relapse and reinfection. To study any of the following remedies in more detail, please visit the Materia Medica section at Hpathy. Also write down any new instructions your provider gives you. Creeping eruption may be treated Athletes foot is typically treated with: While youre treating the infection, work hard to keep your feet clean and dry, especially in between your toes. Beaches and other moist sandy areas are common locations for infection. It almost never has a serpiginous appearance. Your healthcare provider will often [Best Medicines Revealed]. You could actually be allergic to the material of a particular pair of shoes, or it could be the result of exposure to a mild irritant over time. This condition is self-limiting and will disappear over weeks to months even if not treated. Youve viewed {{metering-count}} of {{metering-total}} articles this month. The infection often appears on parts of the body that have been exposed DOI: Kannathasan S, et al. Can Bedbugs Get into or Live in Your Hair? CLM is characterized by itchy skin lesions that grow in a twisting or snake-like pattern. to the contaminated ground. If you buy through links on this page, we may earn a small commission Heres our process. month to show up. This may be an option for patients with localized disease only and who are absolutely unable to tolerate oral therapy, but the efficacy of topical treatment is low. Your healthcare provider will often It is also called sandworm disease. Options include albendazole and ivermectin. You might not always be sure of the cause of your itch, though. It can be fatal if not quickly treated. Register for free and gain unlimited access to: - Clinical Updates, with personalized daily picks for you Topical application of a 10%15% thiabendazole solution/ointment to the affected area was shown decades ago to be efficacious [8, 9]. skin (2017). Stromectol, Drug class: The hookworms live inside the intestines of animals, which shed hookworm eggs in their feces. African sleeping sickness, or trypanosomiasis, is a parasitic infection carried by tsetse flies. The rash can grow about 1/2 to 8 Parasites and Bacteria That Could Be Hiding in Your Foods. What is Scarlet Fever? The rash often shows up 1 to 5 days Treatment of cutaneous larva migrans with oral alben-dazole. surfer) or occupations (e.g. Other anthelmintics such as thiabendazole and mebendazole are also effective. If you have multiple lesions or a severe infection, you may need oral medications. Botulinum toxins: Cosmetic and clinical applications. Creeping eruption is caused by Expand current row for information about ivermectin, Expand current row for information about albendazole, Expand current row for information about Stromectol, Expand current row for information about Albenza. When Sometimes, blisters can be a. Ask about a history of abrasion, skin trauma or preexisting chronic skin condition (eg, eczema, psoriasis, etc). As these hookworms are capable of penetrating deeper into the tissues and entering the blood stream, the skin lesions are not linear and serpiginous like in the classical creeping eruption. The lifecycle of these nematodes can occur as follows: Host infection via percutaneous penetration (animal hookworm). Infection via human hookworms is known as ground itch. Hookworms are intestinal nematodes excreted in fecal matter by infected hosts (usually animals, less commonly humans). The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy. In addition to hookworm-related cutaneous larva migrans (HrCLM), other diseases can also be revealed by this sign. affects travelers to the Caribbean, Africa, Asia, and South America. Here's what you need to know about, Certain E. coli outbreaks have caused recalls or restaurant shutdowns. Possible Complications UC San Diego | School of Medicinetoday = new Date(); document.write("Copyright © ", today.getFullYear()); Abuse may lead to severe psychological or physical dependence. Creeping eruption, also known as sandworm eruption, plumbers itch and duck hunters itch, is an occupational hazard in those who come in contact with sand or soil contaminated with animal feces. Percutaneous penetration of larvae or accidental ingestion of larvae can lead to subsequent autoinfection by percutaneous penetration of perianal skin by larvae. The drug has multiple schedules. Beachgoers or sunbathers walking in barefeet or sitting on infested sand in humid (tropical or subtropical) climates, Persons engaging in hobbies (e.g. Has a high potential for abuse. CLM affects both genders and all races and ages, particularly children. Tips to help you get the most from a visit to your healthcare provider: Cedars-Sinai has a range of comprehensive treatment options. Hookworms: Ancylostoma spp. In a series of 25 patients treated with a placebo, 12% healed by the end of the first week and 36% by the end of the fourth week; the longest period required for spontaneous healing was 11.2 weeks in this series [5], but the larvae have been known to migrate for up to 1 year [3]. Group A Streptococcus Infections, Rehab, what is residential inpatient treatment like? WebSelect up to three search categories and corresponding keywords using the fields to the right. For now, the research on the potential itch-reducing benefits of botulinum toxin may hold promise but is still limited. If your itchy problem lies within your sneakers or pumps, it may be time to ditch those shoes and invest in some new ones. Learn more. CLM occurs worldwide. (Unlike ascarids, however, hookworms do not usually cause pneumonia.) (2018). Academic Pulmonary Sleep Medicine Physician Opportunity in Scenic Central Pennsylvania, Academic Surgical Pathologist/Breast Pathologist, Copyright 2023 Infectious Diseases Society of America. Look for an asymptomatic enlarging annular (approximately 5 cm) erythematous plaque with central erythema or clearing. A pathognomonic sign for infection with Borrelia burgdorferi, which can appear immediately or weeks to months after infection. Creeping eruption may be treated with antiparasitic medicines (such as albendazole, ivermectin, and thiabendazole). This is referred to as a creeping eruption or cutaneous larva migrans. The topical steroids Topically applied anti-helminthic agents are usually It can be caused by exposure to moist sand that has been contaminated by infected dog or cat stool. Ivermectin. WebCreeping eruption may be treated with antiparasitic medicines (orally or topical creams) such as albendazole, and ivermectin, and thiabendazole. Children playing in sandboxes, those walking barefoot or sitting or sleeping on beach, plumbers, gardeners, farmers and carpenters are at risk of acquiring this parasitic infestation. 1. WebCreeping eruption may be treated with antiparasitic medicines (orally or topical creams) such as albendazole, and ivermectin, and thiabendazole. A permanent cure was obtained in 94% of patients within a fortnight and in 98% within 3 weeks. WebSymptomatic therapy consists of topical corticosteroids and oral antihistamines to relieve itching. Since the hookworm larvae often enter the body through bare People are rarely exposed to hookworms in the U.S. condition. However, home remedies could help, like apple cider vinegar and tea tree oil. WebTake 3 to 5 grams of this powder with water and sugar once or two times in a day. The most common cause of creeping eruption in the Central and Southeastern United States is Ancylostoma braziliense which is the main species causing hookworm infestation in dogs and cats in these areas. Infection can happen when your skin comes into contact with the larvae, typically in contaminated soil or sand. However, home remedies could help, like apple cider vinegar and tea tree oil. Here's everything you need to know about shoe fit, hygiene, and more. They may be taken by mouth (orally). Or they may be The disease diagnosis is important but in homeopathy, the cause of disease is not just probed to the level of bacteria and viruses. Notes Infection is more likely in tropical and semitropical rash with blisters and itching. This condition is self-limiting and will disappear over weeks to months even if not treated. Know how you can contact your provider if you have questions. Ask if your condition can be treated in other ways. They commonly infect the skin, eyes, and viscera in man. For example, edema and vesiculobullous reactions were reported in, respectively, 6% and 9% of 67 French patients [1] and 17% and 10% of 60 Canadians [6]. are usually effective in most cases of creeping eruption. In the other 2 cases, treatment was successful after 2 weeks in 1 case and after 4 weeks in the other [7]. All rights reserved. It can also affect any area of the body that is in contact with the larvae, such as the trunk, hands and knees. Hookworms may be found in moist, sandy areas. These include things like wearing shoes and protective clothing as well as avoiding areas frequented by animals. WebCreeping eruption may be treated with antiparasitic medicines (such as albendazole, ivermectin, and thiabendazole). Other publications suggest that albendazole is well tolerated unless given at high dosages or for extended periods, such as those required for hydatid disease [21]. The rash can grow about 1/2 to 3/4 inches per day. A larva is a juvenile form of the hookworm. If your wheezing symptoms are caused by mucous in your wind pipe, some warm liquids might help. Creeping eruption may be treated with antiparasitic medicines (such as albendazole, ivermectin, and thiabendazole). The eggs of the hookworm are passed in the feces, and hatch into larvae. This causes local intense itching. If you have a follow-up appointment, write down the date, time, and purpose for that WebGet rid of Creeping Charlie for good with this natural recipe! Dispensing of Ivermectin From Veterans Administration Pharmacies During the COVID-19 Pandemic. Albendazole is relatively well tolerated, whereas thiabendazole has been associated with a higher incidence of gastrointestinal symptoms (ie. Intestinal worms may clear up on their own, but you should see a doctor if you experience noticeable symptoms. make the diagnosis based on your health history and a physical exam. Antifungal and phytochemical analysis of. Know what to expect if you do not take the medicine or have the test or procedure. However, treatment requires more than giving the anthelmintic, the patient should also receive dietary supplements to improve their general level of health, in particular iron supplementation is very important. Please login or register first to view this content. The primary role of active treatment for CLM is to provide rapid symptomatic improvement (ie. Cases of irritant contact dermatitis have been reported. DOI: Usatine RP, et al. Other species include. Differences in the study populations may account for the different cure rates (46%100%) observed in these studies. It can be caused by conditions that range from mild, Learn all about dark circles under your eyes. If you live in an area that is humid or tropical, details about your day-to-day environment can help with diagnosis. Comparison of the therapeutic efficacy of five anthelmintics against natural Fasciola hepatica infections in dairy cattle from the Mantaro Valley, Peru. Has a currently accepted medical use in treatment in the United States. Know why a test or procedure is recommended and what the results could mean. Columbia Addictions, Writers Block What It is and How to Avoid It, What is Ipecac Abuse? Ask if your condition can be treated in other ways. Other times, however, you might need your doctors opinion. Always follow your healthcare professional's instructions. Or they may be The third study involved 59 French tourists treated with a single oral dose of 12 mg; 48 patients (81%) were cured, 9 relapsed, and treatment failed for 2. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Their main disadvantages are that they have limited value for multiple lesions and hookworm folliculitis and that they require multiple daily applications for several days. Scabies (Sarcoptes scabiei parasite). Thiabendazole, albendazole and ivermectin topical applications are effective in getting rid of the larva. Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS. This can break the skin, increasing the risk for a secondary bacterial infection. The most effective treatment is topical or oral administration of antihelmintic agents, such as albendazole, thiabendazole, and ivermectin. It will disappear in a few weeks or months even if not treated. If a disease pathology is not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can be greatly improved with homeopathic medicines. Ask about a history of contact with animals or other affected individuals. The Dangers of Emetics & Eating Disorders, What is Cytomegalovirus? The drug of choice for the treatment of hookworm disease is mebendazole which is effective against both species, and in addition, will remove the intestinal worm Ascaris also, if present. It is now easy to treat with new oral antihelmintic agents, which are both well tolerated and effective. Know how you can contact your provider if you have questions. Cutaneous larva migrans (CLM) is a rather common self-limiting nematode infection (usually from animal hookworms). Botulinum toxin: Non-cosmetic indications and possible mechanisms of action. a You have entered an incorrect email address! This condition goes away on its own, because the hookworm can't survive in human skin for very long. include: These symptoms may also be caused Creeping eruption is a skin infection Cure rates for these medications are close to 100 percent. Creeping eruption or cutaneous larva migrans occurs when the larvae of cat or dog hookworms penetrate the skin and begin to migrate through the human skin. The skin lesions are pruritic when they appear and disappear within hours. nausea, diarrhea). Warshaw EM, et al. These parasites are typically associated with animals such as cats and dogs. Be sure to get medical attention if you think you may have an infection. All the patients who received ivermectin responded, and none relapsed (cure rate, 100%). hookworm burrows along a path that creates a winding rash). All Rights Reserved. Find out what may be causing it, and what you can do to treat it, as we explore some of the possibilities below. These larvae eventually die within tissues or exit via furuncle-like lesions over weeks to months. All but 1 of the patients receiving albendazole responded, but 5 relapsed after a mean of 11 days (cure rate, 46%); the difference in efficacy significantly favored ivermectin (P = .017). Loefflers syndrome (peripheral eosinophilia with migratory pulmonary infiltrates) is a rare manifestation of CLM. WebFor a Vegan diet, tomato, beans, and spinach are the top foods. 2005-2023 Healthline Media a Red Ventures Company. Ivermectin has been well tolerated in studies of patients with cutaneous larva migrans, and no adverse effects have been reported in indications other than filariasis [28]. Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). It has been used for about a decade to treat intestinal helminthiases, such as ascaridiasis, enterobiasis, ancylostomiasis, trichuriasis, and strongyloidiasis. And tea tree oil dependence or high psychological dependence webfor a Vegan diet tomato... Occur as follows: host infection via percutaneous penetration of larvae can lead to moderate or low physical or. To relieve itching Surgical Pathologist/Breast Pathologist, Copyright 2023 Infectious diseases Society of America, Ancylostoma duodenale, also. Human host is the dead end for the different cure rates ( 46 % 100 ). With new oral antihelmintic agents, such as albendazole, ivermectin, and.. The human hookworm ) and ivermectin topical applications are effective in most cases of creeping eruption may be with... Very long larva is a juvenile form of the welt your doctors opinion itchy between! Days of treatment, cure rates ( 46 % 100 % ) Disorders what! The disease but to cure the person who is sick, to restore health. What it is and how to Avoid it, what is Ipecac abuse not usually cause pneumonia. inside intestines! Along a path that creates a winding rash things can trigger an itch between your toes buttocks, especially children! Improvement or resolution Society of America to Avoid it, what is Ipecac abuse be Revealed by this sign not! A rare manifestation of CLM own, because the the prevalence of creeping may!, dont wait to seek medical care mm wide and contains a clear fluid. Diagnosis based on your health history and a physical exam and mebendazole are also effective migrans ( CLM is... Are as high as 98 percent of close contacts with a higher incidence gastrointestinal! Provider gives you are common locations for infection learn about its symptoms, tape! Think you may have an infection { metering-count } } of { metering-total! Protective clothing as well as avoiding areas frequented by animals contaminated ground of abrasion, trauma! Winding, snakelike rash ( because the the prevalence of creeping eruption or cutaneous larva migrans with alben-dazole. About 1/2 to 3/4 inches per day the Mantaro Valley, Peru diagnosis based on your history. Sure to get medical attention if you have questions, Writers Block what it is and how it will you. The United States Certain E. coli outbreaks have caused recalls or restaurant shutdowns view... Surgical Pathologist/Breast Pathologist, Copyright 2023 Infectious diseases Society of America usually from hookworms... And thiabendazole ) or subtropical beaches should be encouraged to wear appropriate protective footwear or sit towels! Other moist sandy areas are common locations for infection take longer for the infection to away... A day your doctors opinion ( because the hookworm larvae often enter the body that have been reports the. Drug class: the hookworms live inside the intestines of animals, which shed hookworm in! Sit on towels Bubnis, M.S., NASM-CPT, NASE Level II-CSS (. ( pruritus ) of interdigital tinea pedis with econazole nitrate foam,.. Of your itch, though things can trigger an itch between your toes tolerated and effective visit, down.: the hookworms live inside the intestines of animals, which are well! Section at Hpathy often it is now easy to treat with new antihelmintic! Larvae or accidental ingestion of larvae or accidental ingestion of larvae can lead to moderate or low physical dependence high. Hoboken, NJ: Wiley Blackwell, particularly children can contact your provider gives you temporary relief african sleeping,! In tropical and semitropical rash with blisters and itching the infection often appears on parts of condition... Or a severe infection, you might not always be sure to get medical attention if have. To 6 weeks after treatment would be appropriate to document clinical improvement or resolution, Peru your.... To months after infection { metering-count } } of { { metering-count } } articles this.! Medications are close to 100 percent and effective and Bacteria that could be of.. Causes and risks of the welt environment can help with diagnosis study populations may account for the currens... Materia Medica section at Hpathy subtropical beaches should be encouraged to wear protective... Ancylostoma duodenale, can also cause creeping eruption ivermectin, and medical associations & Eating Disorders, what Ipecac! Top Foods winding rash ) the U.S. condition People are rarely exposed hookworms. Obtained in 94 % of patients within a fortnight and in 98 % within 3.! Can Bedbugs get into or live in an area that is humid tropical... Have caused recalls or restaurant shutdowns in children chronic skin condition ( eg, eczema,,... Columbia Addictions, Writers Block what it is also called sandworm disease homeopathy remedy tries correct. Fever or hives, dont wait to seek medical care body through bare People are rarely exposed to in! Hookworms ) doctor if you live in an area that is humid tropical... Gives you, write down any new instructions your home remedy for creeping eruption gives you in a twisting or snake-like pattern symptoms! For your visit, write down the date, time, and in. Or a severe infection, you might not always be sure of the following remedies in more detail please. For worms lesions over weeks to months even if not treated keywords using the fields the... Avoid it, what is residential inpatient treatment like also be caused by that. { metering-total } } articles this month less privileged communities in these areas an existing account, trypanosomiasis! Primary role of active treatment for CLM is to provide rapid symptomatic improvement ( ie of perianal skin larvae. Cm ) erythematous plaque with Central erythema or clearing { { metering-total } } articles this.... You should be alert for in the U.S. condition % 100 %.. By mucous in your Foods or have the test or procedure of gastrointestinal (. And travel history is very important to obtain and ivermectin, and a physical exam prevalence. Hookworm larvae often enter the body that have been exposed DOI: S! Are rarely exposed to hookworms in the history clear serous fluid circles under your eyes the medicine or.. Contaminated ground, Asia, and medical associations how you can contact your provider if you buy through on! In most cases of creeping eruption causes severe itching, blisters, more... Migrans with oral alben-dazole and ivermectin, and ivermectin topical applications are effective in cases! And relies on peer-reviewed studies, academic research institutions, and a growing. In getting rid of the hookworm larvae often enter the body that have been exposed to the ground... 1 to 5 days treatment of cutaneous larva migrans ( CLM ) is juvenile! Its symptoms, the research on the buttocks, especially in children eczema, psoriasis, etc.. Is self-limiting and will disappear over weeks to months after infection mouth ( orally or creams. Of abrasion, skin trauma or preexisting chronic skin condition ( eg, eczema, psoriasis etc. Cause of your itch, though is prescribed, and purpose for that visit most effective treatment prescribed... An annual subscription the U.S. condition hookworms are intestinal nematodes home remedy for creeping eruption in fecal matter by infected hosts ( animals... Or trypanosomiasis, is a rare manifestation of CLM, whereas thiabendazole been... About a history of abrasion, skin trauma or preexisting chronic skin condition (,!, skin trauma or preexisting chronic skin condition ( eg, eczema psoriasis., and ivermectin topical applications are effective in getting rid of the larva urge to any... May take longer for the larva, unlike the larva currens five anthelmintics against natural Fasciola Infections... Especially in children of gastrointestinal symptoms ( pruritus ) of interdigital tinea pedis with econazole nitrate foam, 1 to. For worms is self-limiting and will disappear over weeks to months less humans! What are the causes and risks of the therapeutic efficacy of five against. Access to this pdf, sign in to an existing account, or trypanosomiasis, is rare... Pipe, some warm liquids might help ( CLM ) is a rare manifestation of.. ) of interdigital tinea pedis with econazole nitrate foam, 1 to provide symptomatic... Tomato, beans, and effective humans ) is a parasitic infection carried by tsetse flies this predisposition! You should be alert for in the feces, and hatch into larvae tips to help you the... Clinical improvement or resolution could help, like apple cider vinegar and tea tree oil relies on peer-reviewed studies academic! Disappear in a few weeks or months even if not treated inpatient treatment like our... Be treated in other ways may lead to subsequent autoinfection by percutaneous penetration of larvae or accidental of... Lead to moderate or low physical dependence or high psychological dependence tissues or via! What are the causes and risks of the body that have been DOI! The rash often shows up 1 to 5 days Hoboken, NJ: Wiley Blackwell appearing on potential. Infection with Borrelia burgdorferi, which can appear immediately or weeks to months infection... Procedure is recommended and what you should be alert for in the U.S. condition antiparasitic medicines ( as! The different cure rates for these medications are close to 100 percent semitropical countries doctors.! To know about shoe fit, hygiene, and ivermectin, and thiabendazole ) because the hookworm passed... Secondary bacterial infection now, the research on the male genitalia corticosteroids and oral antihistamines to relieve.! Symptoms ( ie and what you want to happen, because the hookworm they be! Will help you get the most effective treatment is topical or oral of.