Videodermoscopy of Cutaneous Wound Myiasis

An elderly male with long-standing Type 2 diabetes presented with a chronic wound over the right foot. On examination, a solitary punched-out plantar ulcer with hyperkeratotic margins measuring about 3 × 2 cm was noted [Figure 1a]. Floor of the ulcer showed yellowish slough containing grey coloured larvae. Polarised dermoscopy revealed multiple, mobile, greyish-white larvae exhibiting respiratory spiracles, pigmented tracheal tubes and circumferential brown dots [Figure 1b and Video 1]. The clinical and dermoscopic features established the diagnosis of wound myiasis. The larvae most probably belonged to the Calliphoridae family based on the morphological characters.^[1]

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Figure 1:

Punched-out ulcer with hyperkeratotic margins showing yellowish slough and multiple greyish larvae (a). Dermoscopy shows multiple mobile and greyish-white larvae with respiratory spiracles (b, red arrow), pigmented tracheal tubes (b, blue arrow) and circumferential brown dots (b, yellow arrow). (Polarised dermoscopy [DermLite^™ DL3, 3Gen Inc., San Juan Capistrano, CA, USA], ×10).

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Wound myiasis refers to infestation of unattended wounds by the larvae of arthropod order Diptera. Dermoscopy assists not only in confirming the diagnosis by in vivo visualisation of larvae; it also helps in species identification and assists removal of the larvae not visible to the naked eye.