Leishmania-Poor Cutaneous Leishmaniasis
Daniela Kulichova and Thomas Ruzicka
Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
Introduction
Cutaneous leishmaniasis is the most common form of this protozoan disease. First a reddish papule is noted, which can develop into a chronic ulcer. Histologically, numerous amastigotes are present in the cytoplasm of multiple histiocytes, and heavy inflammation is noted. The ulcers are usually painless, but leave disfiguring scars. The diagnosis is seen mostly in tropical and subtropical areas. Solitary lesions can be excised, while another proven approach is local photodynamic therapy.
History
In a 2-year-old, healthy girl from Iraq, a skin lesion on the right cheek had been observed for 8 months. A painless ulcer covered by a gray-yellowish hyperkeratotic crust appeared on top of the initial small red papule. The remaining family members were healthy.
Clinical Findings
On physical examination, an asymmetric, oval, gray-yellowish crust, measuring 4 cm in diameter, surrounded by a slightly red rim, was noted on the patient's right cheek (Fig. 1). The lesion was not painful. After the abrasion of the crust (Figs. 2 and 3) a punch biopsy was obtained for histological verification. No accompanying systemic signs were present.
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