The hookworm inoculation rash

    From Helminthic Therapy wiki

    The rash

    A successful inoculation with hookworms frequently causes an itchy, pink and possibly raised rash at the inoculation site as a result of the immune system reacting to the worms’ entry into the skin. This rash may appear within a few hours, or may take 2 or 3 days to appear. Occasionally, the entry sites may take on a bruised appearance, with black and blue discolouration.

    Some people may have a rash without itching.

    I got very little itch, just barely detectable if at all, but I got easily visible red bumps that stayed for several days. [1]
    I wasn't sure I felt anything, maybe a little tingle but couldn't be sure on that first dose. But they were in. I got two little red dots 2 days later and lots of health improvements 8 weeks later! [2]

    Others can experience itching but no rash, and some may have no physical signs whatsoever.

    I had no initial signs physically to indicate success such as itching or redness etc. [3]

    If there is no rash

    An absence of any indication that the larvae have entered the skin is especially likely if the self-treater is taking an immunosuppressant drug such as prednisone/prednisolone. Even low-dose steroids, such as those used in inhalers, can profoundly reduce the skin reaction to inoculation, although a few subjects who are taking steroids may still develop an itch and/or rash.

    In a few cases, a lack of any skin response may indicate that the larvae failed to survive the rigours of the journey, perhaps as a result of them being exposed to extremes of temperature during transit, especially at altitude during flight, where everything at or near the edge of a pallet will freeze. For more information about this possibility, see Storage and survival of hookworm larvae.

    The absence of a rash may not indicate a failed inoculation

    If there is still no visible confirmation in the first 3 days that inoculation was successful, it might be assumed that the larvae were all dead, but they may not be.

    I had zero rash the first time... No rash the second time either but in both cases gut symptoms... So no rash does not necessarily mean no worms. [4]
    My wife has yet to see any sign of entry on either dose of hers, but has seen huge effects afterwards. Don't take a small or nonexistent reaction to mean it didn't take. [5]
    My first inoculation of 10 HW was 11 days ago and I had absolutely no response at all, nothing on the skin or anything of note since... That is until today when the inoculation site has some small raised reddish bumps. [6]
    I did not get a rash and I did not see any side effects until week 3. [7]
    Whilst I have a nasty rash, my sister has an almost imperceptible rash, and we know ours are alive - home grown! [8]

    In the absence of a rash, the subject may be tempted to add more worms immediately. However, it is advisable to wait rather than immediately order a replacement dose because side effects can appear suddenly, “out of nowhere”, a few weeks after an apparently unsuccessful inoculation, confirming that the original dose was viable after all.

    I inoculated with 10 HW at the end of September. I had zero issues and was thinking of doing a second round of ten right away. Then, in the beginning of November I suffered from a massive increase in stomach acid production, which brought on GERD and gastritis type symptoms, along with other GI symptoms characteristic of HW infection. It was really bad for three weeks... [9]
    Well, I finally have decided (39 days in) that my 10 are there - just a little slow on the uptake. The last couple of days the gut has become increasingly uncomfortable, with some severe pains and quite a lot of dizzy spells. Feeling quite a bit worse for wear, so I guess they were quiet arriving but are now settling in... Glad I decided not to use the replacement dose! [10]
    I actually didn't think the inoculation worked, as I only had a slight tingle for a few minutes and the rash was super light and gone in 3 days with no itching. Fast forward 5 weeks and they've made it clear they're here! [11]

    If these individuals had added a second dose of larvae within the first 12 weeks, they would have faced the possibility of having to run the gauntlet of greatly increased side effects which could have been so severe as to necessitate termination. It may therefore be wise, in the absence of a skin response, to wait for several weeks before reinoculating. One individual who did this after getting no rash, only very minor itching, and no other obvious symptoms in the first few days, suddenly developed the typical gastrointestinal side effects three weeks later, including bloating, nausea, diarrhoea and significant fatigue.

    The absence of a rash may not predict reduced side effects

    My skin reaction was minimal, but systemic reaction all but intolerable... [12]

    Determining whether inoculation was successful

    See Checking whether inoculation was successful.

    Number of red dots may not correspond with number of larvae inoculated

    When there is a rash at the inoculation site, the number of red dots that appear does not necessarily indicate the number of larvae that have entered the skin. Since larvae tend to clump together and are microscopic, several may enter in close proximity, leaving what looks to the naked eye like a single entry point.

    I recently did 6 live wrigglers and dropped them off slide onto bandage ... checked slide for stragglers all good and i got 2 bumps... so unless you are individually applying its not a great way to count them. [13]

    Also, the entry of a single larva can cause what appear to be multiple entry sites.

    The only time I pay any attention to the number of inoculation marks is within the first few hours after applying them, when they are just faint red dots, and even then you can’t get a really accurate count that way. Within a day or two, the entry point for a single larva can look like a whole gang made its way in there. [14]

    With no reliable one-to-one, worm-to-spot relationship, the number of visible entry points can only provide a rough guide to the number inoculated.

    A further complication is that two providers (one of which is no longer trading) have been known to add 10% more larvae to each dose they supply "to compensate for notional losses". So, if there are more entry points than the number of larvae that were ordered, it would be worth checking with the provider whether they added a supplementary number.

    Timing, severity and duration of itching

    If there is itching, this often commences within a few minutes of applying the bandage/dressing, but it can be delayed for a number of hours, and its duration can vary enormously between individuals, from a few minutes to several weeks. The severity of itching and whether it is continuous or intermittent also vary considerably, with occasional itching at the inoculation site being possible at any time during the first few weeks and even occasionally as late as 4 months or more.

    In our case, itching starts in about 3 minutes. [15]
    6-7 min pretty much every time. [16]
    About 10-15 minutes after for me. [17]
    Not until hours after, or even the next day. [18]
    For me it was only about 25 minutes of crazy itching, and it hasn’t itched since. [19]
    It continues for 12 to 24 hours while the bandage is on, then it's gone. (Link expired)
    Still itching and blotchy after 3 weeks, nearly drove me crazy. [20]
    Itching lasted over a month. (Link expired)
    15 weeks post inoculation with HW and the inoculation site is intermittently red, inflamed and itchy. (Link expired)

    In addition to variation in the rash experience between individual self-treaters, there can also be variation in the rashes produced on different occasions in the same individual.

    I’ve been hosting and frequently inoculating for years and just recently I had a very strong inoculation rash. It seems that sometimes the immune system responds stronger than others. [21]

    Skin response may not necessarily predict outcome

    The severity of the skin response is not a reliable indication of a successful outcome from the therapy, and nor is the appearance of a bounce or the presence, absence, or severity of side effects.

    My first dose I had quite a severe reaction at the site, blisters & marks that lasted for ever (but) I have had no benefits to my allergies at all.” [22]

    Persistence of the rash

    The rash may persist for at least 7 weeks in some cases.

    Mine lasted for about 7 weeks and is just now starting to fade. [23]
    I have severe skin reactions and an act up of the site through the 12 weeks and beyond. [24]

    And the rash can reappear intermittently over an even longer period.

    15 weeks post inoculation with HW and the inoculation site is intermittently red, inflamed and itchy. [25]

    In one case involving a 4-year-old boy with a suspected mast cell disorder, a third inoculation of 10 NA caused a persistent rash and also reactivated the rash at the site of his second inoculation (also 10 NA). Both rashes then remained “constantly itchy/painful and bumpy” for 7 months until a helminthic therapy-aware doctor recommended high doses of antihistamines and mast cell medications, which quickly resolved the rash. The problem in this case was likely to have been that the number of larvae inoculated was too high for a child with a suspected mast cell disorder. (See Helminthic therapy and mast cell disorders for more about the use of HT in subjects with MCAD/MCAS.)

    Future reactivation of the rash

    The inoculation site may suddenly flare and become itchy again weeks or months after an inoculation. This might occur when the worms start to attach to the inner wall of the intestine to feed for the first time on or after day 21, or at the peak of the immune response to a new batch of worms at around 7 weeks.

    This phenomenon may be the result of the L3 larvae having shed their cuticles and sheaths at the time of their migration through the host’s skin. Approximately 30% of these sheaths are left above the surface, while roughly 70% are carried into the skin, where they interact directly with the host's immune system. [26] [27] When the immune system detects similar material during the later stages of the worms’ migration, and when they begin to feed from the intestinal wall, there is a release of antibodies to those types of cells or proteins wherever they occur, including in the skin, which can flare as a result.

    Several hookworm self-treaters have reported a reactivation of the inoculation site on or around day 12, [28] [29] and another experienced a flare of her rash at 7 weeks. [30]

    Inoculation sites may also flare temporarily following new immune challenges. For example, one self-treater experienced a rash at an old inoculation site when exposed to the sun for the first time in a while. [31] And others have had old rash sites flare after contracting COVID-19. [32] [33]

    Treating the itch

    After self-inoculation with hookworm larvae, the bandage/dressing should be left in place for a minimum of four hours and, ideally, for twelve. If the larvae are applied in the morning, the bandage/dressing can be removed before going to bed at night, making it easier to treat the itch and thus prevent sleep being lost as a result of discomfort during the night. Although some people prefer to inoculate just before going to bed because they can sleep through the itching.

    If the resulting rash is itchy, this can be treated after removal of the bandage/dressing.

    An electric hair dryer - gold star tip!

    An electric hair dryer provides the gold standard treatment for a hookworm itch. Hot air is directed from the dryer at the centre of the rash and held up to the point of feeling momentary pain. This will usually stop the itch completely for a number of hours, but one does need to be careful not to cause a burn! More details here.

    The hairdryer trick works a treat. I ended up sleeping with mine beside the bed for a couple of days. [34]
    I’m using a combo of hair dryer and an ointment for psoriasis. Active ingredients are: calcipotriol and betamethase. That combo allows me to sleep through the night. [35]

    The The Bite Away device

    Like hair dryers, some devices marketed for the treatment of insect bites and stings use heat to nuke an itch, and these can be effective for the rashes caused by inoculation with a small number of NA larvae.

    I think I found something that works really well for the inoculation itch - the "bite away" stick. The evening before yesterday I did my 2nd inoculation (5NA) and it kept on itching for the whole night and the next morning. I put on corticosteroid cream, took antihistamines, all to no avail. Then I saw the stick in our bathroom and decided to try it. The itch stopped immediately and has not returned. [36]

    Since these devices are pocket-sized and battery-powered, they are also very portable. However, they do cause intense, if momentary, pain with each application, and they need to be applied accurately to each entry point, which can become tedious when dealing with a larger inoculation rash with many entry points. These devices may also not be fully effective if any larvae have travelled laterally beneath the surface of the skin during the first couple of days. In such cases, a hair dryer is the better option.

    Oral Moducare supplement

    One hookworm host has reported that taking this blend of plant sterols and sterolins got rid of her inoculation itch for hours. [37]

    Oral antihistamine products

    Oral antihistamines may help to relieve the itch but, unfortunately, some of these contain drugs that have anthelmintic properties. While it is unlikely that anything will harm hookworms before they attach to the gut mucosa (towards the end of the third week, post inoculation) some of these drugs may harm mature hookworms. The following guide is intended to help navigate the available antihistamine drugs.

    Allegra really helps mine. I take it daily until the itching slows down. [38]

    Topical antihistamines

    Topical products containing 2% diphenhydramine hydrochloride are very effective and are available in several forms. An alcohol-based version may perform marginally better than a cream, but whichever form is used, diphenhydramine is ideal because it works as an antihistamine as well as a local anaesthetic. Available in both the US and UK - from Amazon, Ebay and other outlets and may also be available in other countries.

    If there's no topical antihistamine prodct to hand, crush an antihitamine tablet with a little water and apply the mixture.

    I put a little water in a cup, crushed a Benadryl tablet. Soaked a circular face cleaning pad in it. I taped pad to the inoculation site. No more itch. [39]


    Oral painkilling drugs can be very effective in quieting the itch for several hours, so are very helpful at night.

    I generally take a dose of oral painkiller before bed on the first night after re-inoculating, in addition to using topical measures including a hair drier... [40]

    Painkillers can also be crushed and applied directly to the rash on a dressing / bandage for topical relief. [41]

    Steroid creams

    A maximum strength (1%) hydrocortisone cream is another treatment option for the itch, e.g.

    The more potent, prescription-only topical corticosteroid, mometasone, may be more effective than hydrocortisone.

    Mometasone is two classes above hydrocortisone so I would expect it to be much more effective. [42]
    I use mometasone and I don't get any itch whatsoever after inoculation, just a tingle. [43]

    Non-steroidal creams and lotions

    Any topical allergy or itch treatment - such as vaginal itch relief creams - should work to varying degrees, and other treatments that have been reported to work include the following.

    • Topical anaesthetics One NA host reported that the product, "Soov" (Lidocaine [Lignocaine] hydrochloride monohydrate 1% , Cetrimide 1% , and Chlorhexidine gluconate 0.2%.) numbed the very sore rash site on her leg enough to allow her to sleep. [44] However, there is a small possibility that fresh L3 NA larvae, which remain within the skin at the inoculation site for the first 40 hours, may be adversely affected by the use of a topical anaesthetic applied directly to this area following inoculation. [45] Further feedback is needed to confirm or dispel this possibility.
    • Calamine lotion One individual says this gives him at least two hours relief, and someone else, who had tried Benadryl lotion, prednisolone, cortisone cream, “some sort of anti/itch numbing spray” and oral antihistamines, has claimed that calamine lotion beats them all. [46]

    Anything that moisturises the skin can help to ease the itch, especially once any oozing has stopped and the rash site is dry.

    I have found the best thing for me is to keep it moisturized. I just use a good quality lotion. [51]

    Essential oils

    Several essential oils have been reported to help, including sandalwood oil [52] and magnolia oil. While the latter worked in the short term to control the itch and prevent scratching, [53] ice can also be effective, and it's cheaper! [54]

    Lavender, rosemary and ylang ylang essential oils contain beta-carophyllene, which helps speed wound healing and also reduces the chances of scar tissue. [55] Two drops of lavender oil, applied on a bandage, calmed one user’s itch almost immediately and allowed her to forget about the rash completely. [56]

    The quality and purity of essential oils may influence the extent of their beneficial effects.

    Magnesium sulphate (Epsom salts)

    One hookworm host has had success using an Epsom salts (magnesium sulphate) solution. This reportedly eased the itch, stopped the weeping and generally dried up the rash site. [57]

    I have been rinsing the spot with Epsom salts on second day and it queitens the itch and redness for me.... Basically the itch stops 99%. I just used a 1/4 teasp (of magnesium sulphate) in a tiny bit of water then pour over and rub in. Then just let air dry. The scab seems bigger but its not as most of it is the drawn out liquid dried. Underneath was a tiny scab, but the redness was down and the itching gone. Just makes it a non event for me. [58] [59]

    Others have used magnesium sulphate paste with similar success.

    After 12 hours I use Magnesium Sulphate paste available from pharmacists/ chemists. Small pot of white paste (you don't need much). Stir it up with a spoon handle till it’s smooth. Then apply to the blistered entry points and use a non-absorbant dressing (shiny side on the blisters) over the area. Stick down with micropore tape and leave for 24 hours. Wash it with clean water. Leave for a couple of days and repeat once more. It helps stop the itch and heal the blisters. The paste draws out the deposits of proteins etc., by an osmotic reaction. [60] I wouldn’t repeat the treatment with the paste more than twice unless the itch is still there after a couple of days and / or the blisters return. Repeated use of the paste may dehydrate the skin area too much. [61]

    Someone else who applied Epsom salts as a paste also found that it worked, but said it was messy. [62]

    Homeopathic sulphur

    One individual has found homeopathic sulfur (1M potency) best for an itchy, burning inoculation rash. She says that, while frequent dosing was needed initially in response to the symptoms, consistent use after subsequent hookworm doses may gradually reduce future rashes, requiring less need for the sulphur remedy over time. She also found that homeopathic Histaminum was mildly helpful, but not as much as the sulphur. Her full protocol for using the sulphur is here.


    This product combines aluminum sulfate tetradecahydrate with calcium acetate monohydrate. Together with water, these astringent ingredients form aluminum acetate.

    Domeboro Medicated Soak worked wonders for one self-treater's rash.

    I had my worst worm rash and was camping, so no access to a hairdryer. Went to a pharmacy for more bandaids and found this stuff. It worked amazingly well! [63]

    Domeboro is also available as a cooling gel, which might be more convenient for treating a hookworm rash.

    Miscellaneous substances

    Others have reported success with a variety of substances, including honey, natural pawpaw cream, sea or salt water and even toothpaste!

    Toothache gel has also proved to be successful.

    I use toothache gel.. i put it on a bandaid over the entry. works awesome for me. [64]

    One self-treater was particularly impressed with the results of using snail mucin. [65]

    By the 4th day the itch was strong, I developed welts, my skin was irritated and red, and the site was weeping. I placed a small layer of snail mucin over the inoculation site and covered it with a bandage overnight. The next morning the area was significantly less inflamed and less red. The welts had gone down, the weeping had ended and the itch had decreased. I then applied additional mucin over the next 2 days, and the only symptom I have now are some red dots. (Via private message.)

    Someone else found relief from applying alcohol.

    My last rash was super itchy and weepy. The hand sanitizer spray (just alcohol) was sitting right there and I just sprayed it on, hoping to dry out the rash. It worked like a dream. I added a little clary sage essential oil to it and it's even better. This time around my rash never got too bad or too itchy and it cleared up in record time. The alcohol didn’t sting at all and was very soothing. [66]

    Adding a small dose of TSO or TTO

    Several NA hosts have found that taking a dose of between 83 and 250 TSO two hours before inoculating with NA reduces their skin response to the hookworms, perhaps by distracting the immune system from the activity at the inoculation site.

    TSO just before NA has a 90% reduction in NA skin response for me. [67]
    Retreated with NA 3 days ago. I took a small dose of 83 TSO (0.5ml from a bottle of 2,500) beforehand. The itch and response to my skin has been calmer so far. More like annoying ant bites vs. massive whelps. [68]

    Even taking the TSO after inoculation with NA has helped in one case.

    I decided not to take TSO with this dose and was going to “tough it out.” Three days later, I was still having worm flu and my area of inoculation was very painful, so I decided to go ahead and take some TSO to see if it would help. (I took 0.5ml from a bottle of 2500, which gave me 83 ova.) And thankfully it has!! It really does help with the side effects. [69]

    Other NA hosts have found that, while regularly taking 250 TSO every 2 weeks, their NA inoculation rashes have resolved much more quickly. They commented, in particular, on a marked shortening of the oozing stage.

    And one self-treater has had success with even an extremely small dose of TSO.

    I’ve found that a small dose of TSO dulls the rash considerably (anywhere from 25+ ova). [70]

    For how to divide the contents of a bottle of TSO, see Dividing doses.

    The human whipworm, TTO can have a similar beneficial effect on the severity of skin response as TSO.

    I use TTO 3-5 days before NA application, it really helps to keep the NA itch minimal. [71]

    Keeping the rash covered

    One person says that she finds the best way to deal with the itch is not to touch the rash at all with fingers, creams or clothes, etc., as any friction over the area increases the itch. So, while it’s hard to achieve, she finds that just keeping the rash covered and restraining her urge to touch it is what works best for her. Another agrees about covering the rash.

    I use hydrocortisone cream and a gauze wrap (very snug) over the top. The snugness helps dampen the itch and prevents you from scratching it in your sleep! [72]

    Someone else has found that transparent film dressings are particularly effective against the itch, e.g., the 2 3/8 inch x 2 3/4 inch transparent dressings from the US Amazon site or the 6 x 7 cm ones from the UK Amazon site

    These things are extremely helpful for itch. They cut the itching dramatically, and when you do scratch, you can do it right over the film. [73]

    Yet another individual has found hydrocolloid bandages/dressings very effective.

    Hydrocolloid bandages (blister bandages) are wonderful. They not only help subdue the itch but also absorb the fluid that weeps from the blisters. [74]

    Applying pressure

    Some people have found it helpful to apply pressure to the rash using an elastic bandage.

    ... using a tensor bandage around the site; the pressure/tension seems to help lessen the itchiness. (I have bees, and this really helps a lot for stings on arms/legs but a bit less effective for the inoculation itch.) [75]
    Get some medical tubing to apply some gentle compression, long enough to cover all of the swelling and a bit more - and an extra piece so you can double it. I find the hug of the fabric helps with the itch. [76]

    Striking the rash

    A few others have reported getting up to half a day’s relief from the itch after giving their rash several hearty slaps. In one case this is done after applying hydrocortisone cream.

    Ice packs

    An ice pack has been found to provide effective relief by some people.

    My husband used the ice pack - on for about 1/2 hour before going to bed each night helped enough that he wasn't kept awake by the itching. It also helped decrease the swelling around the inoculation rash. During the day, he would just put on the ice pack for 15- 30 min, whenever he had a chance and it seemed to make it better for an hour or so at a time. [77]
    Icing it for 15 minutes took care of it. [78]
    I use ice packs at night, usually just 2 nights. [79]

    Avoiding the rash and itch

    If the itch is severe, it can often be avoided by inoculating at a different body site, especially one where the skin is less sensitive, such as the outer, rather than the inner, forearm. Some self-treaters have also had success using the underside of their feet, especially if they have more hard skin on their sole from walking barefoot, but there are others who dislike using the arch of the foot. For more about this, see, Body sites used for hookworm inoculation.

    I have found that if I inoculate on sensitive skin, I get all the rash. I switched to using the top of my forearm (trucker-tan area), instead of the soft under side of my forearm. The switch has been wonderful. Underside nearly scarred. Topside, itch, yes, but visually invisible and not swollen. [80]
    My husband's NA rash on his forearm became intolerable... his whole arm would swell and the whole tissue would itch insanely. He really was reluctant to inoculate any more larvae. After ten months his snoring returned, so I convinced him to try the sole of his foot... he chose the instep. I thought I would try my heel. We both experienced a very slight tingle for a second about an hour after inoculation. The next morning my husband had clear signs of larvae entry and a very mild irritation... me, nothing. After 3 days my husband's foot is just fine... the rash does not bother him at all... and my heel has only just started to indicate that larvae entered the skin... with an almost unnoticeable itch... like I have a tiny prickle in my foot. [81] I have tried both my heel and instep. It took 3 days for the heel rash to appear, but only overnight for the instep. The instep rash was much more apparent and more itchy... but nothing like the forearm rash. [82]

    People who grow their own larvae have the option of applying single larvae on individual dressings at different sites, which can greatly reduce both the itch and the rash.

    ... if you incubate, you can put worms on a couple different bandaids and not have those major single point of entry spots. [83]

    Managing an angry, weeping rash

    This section applies to the rashes produced by supplementary inoculations rather than a first inoculation.

    A pumice stone or other abrasive

    Once there are pronounced yellow heads or blisters at the points of entry, scrubbing away everything that stands above the skin surface can bring remarkably swift relief from the itching and help reduce the possibility of swelling. This is probably because the scrubbing removes the debris left behind by the larvae when they entered the skin, thus taking away what the immune system was reacting to.

    I pretty much just rip the skin off now as soon as the blistering starts. Not elegant, but it does seem to help it clear up sooner and relieves the itching. [84]
    (Pumice stone) definitely has made a big difference. No inch this morning. [85]

    A rough towel, loofah, or surgical nail brush may remove the heads, but a pumice stone can be even more effective. [86] One hookworm host uses a men's pocket hair comb to scrape/rake repeatedly across the area, with the long edge of the comb aligned in parallel to the direction of movement. Another uses her fingernails [87] and one brave helminthophile pours table salt onto the rash and scours this with a paper towel, [88] although someone else who tried this commented that it "Burns like the dickens for a while!" [89]

    Removing the heads will leave shallow craters which may weep, sometimes quite profusely, for a few days. However, the fluid released is just exudate, or serous drainage. It is very unlikely to be suppuration (pus).

    There have been no reports to date of infections taking hold at inoculation sites, even when the skin is broken, and this may be because the heightened immune activity around the rash defeats any opportunistic bacteria. There should therefore be no need for the use of antibacterial preparations.

    Panty liners

    Keeping the site covered with a thick, absorbent dressing will help prevent staining of one's clothes. Panty liners are excellent for this purpose.

    I cut panty liners into 2 or 3 sections depending on the size of the rash, and keep replacing these till the rash dries up. The waterproof backing prevents any liquid seeping through to one's clothes. [90]
    I've bought small tight athletic socks and cut the toe end off to create a "sleeve", inside of which I put very thin sanitary pads to absorb the liquid. [91]

    Clay poultice / lavender oil

    One self-treater has found that following up the scrubbing with a clay poultice and/or lavender essential oil provides even more benefit.

    Dickinson's Witch Hazel

    Dickinson's Witch Hazel, dabbed on with cotton balls has provided soothing relief for the rash and a 75% reduction in swelling, itching and weeping within approximately half an hour. [92]

    Homeopathic graphites

    Some people have applied the homeopathic remedy, graphites, to their oozing rash, and this can be purchased as a cream, e.g., Nelsons Graphites Cream 30g. However, there have been no reports as to how effective this might be in the case of a hookworm rash.

    Table salt

    I have Celtic grey salt... and that's what I rubbed in. It helped a lot! [93]

    Someone else applies a bandage covered in normal table salt, claiming that this "makes all the liquid come out really fast, and helps dry the scabs real soon." [94]

    Combining treatment options

    After trying out several different treatment approaches over many inoculations, self-treaters will often settle on a range of options that they combine to make their inoculation routine far less eventful than it would otherwise be.

    For example, one NA user who, without remedial measures, always experiences a severe reaction to every inoculation, starts by taking the maximum permitted dose of a hookworm-safe antihistamine just before inoculating, along with a small dose of TSO obtained by drawing off 1.5 ml of liquid from a bottle of 2,500 TSO. The antihistamine helps reduce the initial itch, and the TSO helps to distract the host’s immune system away from the new NA.

    This self-treater inoculates early in the day so that the bandage can remain in place for 12 hours before he goes to bed. When the bandage is removed, he applies hot air from a hairdryer to the inoculation site (see above for details), and repeats this as required during that first night and throughout the second day.

    Yellow peaks will have started to appear at the entry points by the second evening, and these are scoured off using a pumice stone before he goes to bed. Provided that the site is re-scoured whenever there is any sign of itching, the worst of the itch is effectively over from 36 hours after the inoculation, and healing of the entry points will have begun, with only minimal oozing from that point onwards.

    The use of this particular combination of treatments by this individual has greatly reduced the severity of the itch, the degree of oozing from the entry points, and the extent of the area of "angry”, red, swollen cellulitis that previously always appeared around, and for several inches beyond, the inoculation site. And it has shortened the entire healing process by a couple of days.

    Development of inoculation rashes over time

    The first few hookworm doses tend to produce a successively more pronounced skin rash as a result of memory cells keeping a record of their previous encounter with the organism. [95]

    The fourth and fifth inoculations can leave some people with a very angry-looking bright red rash which can develop fluid-filled blisters/vesicles that may ooze exudate or serous drainage.

    I got almost no itch with the first dose of HW. As I understand it, the immune system isn't prepared for that first intrusion through the skin. But by the second dose, your little soldiers are alert and they converge quite intensely on the migration site. My 2nd, 3rd, and 4th skin reactions grew increasingly severe. [96]
    My 4th is still itching and blotchy after 3 weeks, nearly drove me crazy. [97]

    Occasionally, someone may experience the worst rash after their sixth inoculation.

    Mine escalated until the 6th which was the absolute worst. [98]

    Some people begin to experience less severe rashes after the fourth or fifth inoculation.

    My response increased for the first few - my fourth was the worst. Oozed for 10 weeks and left a noticeable scar. Subsequent inoculations have gotten easier. My seventh quit oozing by 5 or 6 days and was completely healed in 2 weeks. [99]
    For me the 5th was by far the worst, so it was a real relief when my reaction to the 6th dose was vastly smaller. [100]

    Others can continue to get very angry and itchy rashes indefinitely.

    I always get a swollen runny angry rash. It takes a couple months to disappear. [101]

    Some people may eventually develop an additional area of inflammation extending for several inches around the rash and perhaps even affecting most of the upper or lower limb used for the inoculation. This area of cellulitis may appear bruised, can be quite swollen, and may also be as itchy as the rash itself. Once this reaction has presented, it can recur with each subsequent inoculation.

    I inoculated two days ago with 25NA, which is my normal. I put them on the calf of my leg. Today my lower leg is visibly swollen and tight down through the ankle. Doesn't really hurt, but I don't really remember this happening before. [102]
    I use my inner forearm and this always swells up extensively for a few days, with the swollen area getting very itchy too. [103]
    I never had the swelling down the rest of my arm with my first dozen doses but it did happen with my most recent one. Odd. [104]

    But some successful supplementary inoculations may fail to produce any reaction.

    My last one, #6, gave me practically no itching at the time. Definitely worked though. [105]

    Others have reported their experience of the intensity of the inoculation rash after each dose of NA in this Support group thread.

    In a few people, the rash severity may reduce significantly after hookworms have been hosted for more than 6 years.

    The possibility of marking/scarring at the inoculation site

    Hookworm inoculation does not leave a permanent scar, but can cause temporary scarring and leave a visible mark that persists for a time. This marking may appear to be permanent if the same site is used repeatedly.

    I’m 20 weeks in and I have the worst raised scar from inoculation with 10 hw. This is my third inoculation. (Link expired)
    Mine haven't left scars as such, though sometimes the inoculation site remains red for many weeks. [106]
    I had a few marks but they all seem to disappear in 3-4 months... compared to other scars I have its unnoticeable. [107] [108]
    My fourth inoculation was the worst, still oozing at 10 weeks, and left a scar. They got better for me after that. (Link expired)
    The last mark has not disappeared - its a scar now. I honestly don't care about that though as it's not much to pay in exchange for what the worms have done for me. [109]

    Some areas of skin appear to be less likely to develop marking/scarring.

    I put mine on my mid thigh as I'm not prone to wearing short skirts or tiny shorts. I put one lot on my arm and that scarred much worse. [110]

    The risk of temporary scarring can be reduced by spreading the larvae around the bandage/dressing, thus preventing any areas of particularly intense inflammation.

    When inoculating I try and spread the dose around the bandage as much as possible so the HW do not group together when entering the skin. I find this leaves less of a long term mark. [111]

    If the same site is always used for inoculation, this area may, over time, develop a semi-permanent, faintly mottled "shadow" of slightly darkened skin, which is another reason to use a less visible area for inoculation. (See Body sites used for hookworm inoculation.)

    See also