Access Dermatology

Summary

Leishmaniasis is a vector-born disease caused by obligate intracellular parasites of macrophages, Leishmania, which are transmitted by infected female sandflies. The incidence of cutaneous leishmaniasis approaches 2 million new cases a year with a large majority of cases reported in nine countries of the "Old World", and Latin America. Infection may be restricted to the skin with development of characteristic ulcers, or may affect the mucosal membranes in its mucocutaneous form. The various clinical forms of the disease reflect the fascinating immune-pathogenesis of leishmaniasis. Clinical diagnosis is verified by the presence of amastigotes in slit-skin smears, by parasite culture, and newer polymerase chain reaction (PCR) techniques that permit Leishmania species identification. Therapeutic modalities include both systemic treatments (pentavalent antimony compounds, sodium stibogluconate, lipid formulations of amphotericin B, oral ketoconazole or itraconazole) and topical treatments (paromomycin sulfate, local heat, freezing with liquid nitrogen, or photodynamic therapy). Effective vaccines are still not available and the focus of extensive research.