Cutaneous Leishmaniasis (CL)

Cutaneous leishmaniasis is the most common form of leishmaniasis and is found in several regions, including the Americas, the Middle East, and Central Asia.

Cutaneous leishmaniasis causes ulcers on exposed areas of the skin, which may persist for months and sometimes for several years. The lesions may appear years after infection, especially in cases of weakened immunity. It typically begins as papules, then progresses into ulcerative sores with raised edges and a depressed center, sometimes covered with a thin crust. The ulcers are usually painless but may become painful if a secondary bacterial infection occurs or if they are located near a joint. After healing, they often leave atrophic scars.

Mucocutaneous Leishmaniasis

This form affects patients several months after the healing of skin ulcers and leads to partial or complete destruction of the mucous membranes of the nose, mouth, throat, and surrounding tissues. It may appear months or even years after skin lesions have healed. Although it is a form of cutaneous leishmaniasis, it is more severe. Unlike most forms of cutaneous leishmaniasis, it does not heal spontaneously, and in severe cases it can be fatal if left untreated. About 90% of cases occur in Bolivia, Brazil, Ethiopia, and Peru.

Leishmaniasis Recidiva (Relapsing Leishmaniasis)

Relapsing leishmaniasis may reappear years after the healing of localized skin papules and plaques, usually on the face. New ulcers and papules develop at the edges of old scars and spread inward, forming psoriasiform lesions. This may result from reactivation of dormant parasites or reinfection with a different species. It can reactivate an apparently dormant primary infection, and this form is often resistant to treatment.

Post-Kala-Azar Dermal Leishmaniasis (PKDL)

This form appears months to years after recovery from visceral leishmaniasis. It presents as new skin lesions consisting of hypopigmented macules, plaques, and pinkish-yellow nodules without ulceration, which distinguishes it from direct cutaneous leishmaniasis.

Complications of Cutaneous Leishmaniasis

Cutaneous leishmaniasis may lead to bleeding and severe skin infections, which can be fatal in immunocompromised patients. It can also cause severe disfigurement and atrophic scarring, particularly on the face and exposed body areas.

Diagnosis of Cutaneous Leishmaniasis

A dermatologist performs a clinical examination, followed by skin tissue sampling. Samples are sent to the laboratory for microscopic examination and culture to identify the parasite.

Identifying the specific Leishmania species is important, especially when multiple species are present in the patient’s environment, as each species may have different clinical manifestations. Parasite species can also be identified using biochemical techniques such as isoenzyme analysis of cultured parasites.

Drug Treatment

Oral treatment: In 2014, the U.S. Food and Drug Administration (FDA) approved miltefosine for the treatment of all types of leishmaniasis in adolescents and adults over 12 years of age weighing at least 30 kg.