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Cutaneous Leishmaniasis

Last updated April 15, 2021

Reviewed by: Lester Fahrner, MD

Approved by: Krish Tangella MD, MBA, FCAP

Leishmaniasis is a widespread, global disease that is caused by protozoa (of the Leishmania genus), which is transmitted through the bite of an infected female sandfly (a type of insect) in the tropical and subtropical regions.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Chiclero's Ulcer
  • Dermal Leishmaniasis
  • Oriental Sore

What is Cutaneous Leishmaniasis? (Definition/Background Information)

  • Leishmaniasis is a widespread, global disease that is caused by a protozoa (of the Leishmania genus), which is transmitted through the bite of an infected female sandfly (a type of insect) in the tropical and subtropical regions
  • There are 3 main types of Leishmaniasis that include:
    • Cutaneous Leishmaniasis, which affects the skin 
    • Mucocutaneous Leishmaniasis, which affects the skin and mucous membrane
    • Visceral Leishmaniasis, which affects the entire body (systemic)
  • Cutaneous Leishmaniasis is the most common form of Leishmaniasis and it presents skin signs and symptoms (lesions and ulcers), typically at the bite site. It can be caused by nearly 15 different species of Leishmania protozoa, which are mainly found in Asia (central region and middle east), Mediterranean region, and north and south America
  • People who generally belong to economically weaker sections in the endemic regions, have a high risk of infection. Those who stay or travel to the rural areas are more exposed than individuals in  urban areas
  • It is characterized by open lesions on skin, which ulcerate and then heal with pigmented scars (skin disfigurement) that are permanent. The infection may be accompanied by fever and fatigue. The complications may include severe scarring of the skin and secondary infections
  • The treatment of Cutaneous Leishmaniasis involves medications and topical applications. It is based on the type and severity of the infection. Since, human infection can be caused by many different species of Leishmania; the treatment also depends upon the geographical location. However, a spontaneous resolution of the skin ulcers is also observed in some cases
  • The prognosis depends upon the promptness in providing treatment. The prognosis of Cutaneous Leishmaniasis is generally good, but severe complications can result in permanent scarring of skin or even fatal infections

Who gets Cutaneous Leishmaniasis? (Age and Sex Distribution)

Individuals of all ages are at risk for Cutaneous Leishmaniasis infection, if they are exposed to sandfly bites. There is no gender, race, or ethnicity preference noted. However, Cutaneous Leishmaniasis is endemic to certain regions/countries of the world as indicated below:

  • Afghanistan
  • Algeria
  • Bolivia
  • Brazil
  • Colombia
  • Iran
  • Peru
  • Saudi Arabia
  • Syria

What are the Risk Factors for Cutaneous Leishmaniasis? (Predisposing Factors)

The risk factors for Cutaneous Leishmaniasis may include:

  • People living at the following geographical locations (tropics and subtropics):
    • Africa
    • Asia
    • Middle-East Asia
    • North America
    • South America
    • Southern Europe
  • Traveling or visiting places where Cutaneous Leishmaniasis is common
  • Climatic conditions and environmental changes can increase the risk of Leishmaniasis. These include deforestation, development and expansion of cities, and construction of dams
  • According to the World Health Organization (WHO), certain socio-economic indicators point to a higher risk of infection. These include:
    • Poverty
    • Malnutrition
    • Famine
    • Illiteracy
    • Lack of sanitation and proper hygiene
    • Large-scale migration and settlements
  • Leishmaniasis is more common in the villages and small towns (especially in the outskirts) than in the cities
  • Individuals with weak immune system owing to factors, such as HIV infection or other diseases

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Cutaneous Leishmaniasis? (Etiology)

Cutaneous Leishmaniasis is an infectious disease caused by the bite of sandflies; small flying insects that are smaller than mosquitoes and less noisy. The sandflies transmit Leishmania organisms, which are protozoan parasites, in blood causing the infection.

  • More than 15 different species of Leishmania parasites have been identified and studied. Some of these include:
    • L. aethiopica
    • L. amazonensis
    • L. braziliensis
    • L. guyanensis
    • L. infantum
    • L. lainsoni
    • L. lindenbergi
    • L. major
    • L. Mexicana
    • L. naiffi
    • L. panamensis
    • L. peruviana
    • L. shawi
    • L. tropica
    • L. venezuelensis
  • An uninfected sandfly gets infected by feeding on the blood of infected people or animals (such as dogs, cattle, foxes, or rodents)
  • The transmission risk is high from dawn to dusk when the sandflies are active

What are the Signs and Symptoms of Cutaneous Leishmaniasis?

Only a small subset of infected individuals develops signs and symptoms of the infection. The signs and symptoms of Cutaneous Leishmaniasis include:

  • At the bite site(s), formation of a skin sore (may be more than one)
  • If the infection severity increases, the skin sores may spread in area. Also multiple sores may form
  • The skin lesions then become nodules, and the nodules develop and ulcerate
  • The local skin turns more pigmented
  • Persistent rashes can be found in the body
  • The skin symptoms may be accompanied by fever, fatigue, and general malaise

How is Cutaneous Leishmaniasis Diagnosed?

A physical examination, assessment of the signs and symptoms, and medical history evaluation of the infected individual may be indicative of Cutaneous Leishmaniasis. However, the healthcare provider may perform the following tests to definitely diagnose the condition:

  • Blood tests to detect antibodies against the parasite
  • Montenegro skin test: It is generally not a very effective method to aid in the diagnosis
  • ELISA (enzyme linked immunosorbent assay) test to check the level of antibodies in blood
  • Examining tissues under a microscope to detect the parasite: The infected area (skin) is scraped and sent for a biopsy
  • Polymerase chain reaction (PCR) test are conducted during the biopsy examination
  • Tissue culture tests

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Cutaneous Leishmaniasis?

Cutaneous Leishmaniasis is the mildest form of Leishmaniasis and is typically not fatal. But, if left untreated, it may lead to complications such as:

  • Facial disfigurement; permanent scarring of skin necessitating cosmetic surgery
  • Mucosal perforations
  • Secondary infections of bacteria, virus, or fungus
  • Deadly infections due to immune system damage

Inadequately treated Cutaneous Leishmaniasis can result in Mucocutaneous Leishmaniasis after many years, which is a severe and invasive form of Leishmaniasis.

How is Cutaneous Leishmaniasis Treated?

The treatment for Cutaneous Leishmaniasis differs from one individual to another. Proper consultation with the infectious disease consultants and public health officers are generally recommended before treatment starts. The treatment measures include:

  • Oral medicines and topical ointments/applications for skin lesions
    • The skin ulcers may heal without treatment; the administration of appropriate medications can prevent scar formation
    • If the ulcers heal and cause cosmetic disfigurement, then plastic surgery may be performed
  • Intravenous medications (that may include intramuscular injections)
  • For fungal (secondary) infections that develop due to Leishmaniasis, antifungal medication are prescribed

The medications administered vary depending upon the type of Leishmania species causing the infection.

How can Cutaneous Leishmaniasis be Prevented?

Currently, no vaccination has been discovered to prevent Leishmaniasis. Research is being undertaken to develop a vaccine at the earliest. Nevertheless, the following preventive and precautionary measures may be taken to reduce the spread and impact of Cutaneous Leishmaniasis:

  • Avoid exposure to sandfly bites
  • Wear protective clothing, such as long sleeves, long pants, and socks, to protect the skin from the insect bites; minimize exposed skin areas
  • Use insect repellents containing DEET, permethrin, or deltamethrine; one’s clothing and bed can be suitably sprayed with the repellents
  • Prevent entry of sandflies into homes by keeping the windows and doors suitably closed; use finely-meshed bed nets (that are tucked into the mattress) while sleeping
  • Sandflies are more active during dusk or at night; knowing their pattern, one can take steps to minimize outdoor activities or take suitable preventive measures against the bites accordingly 
  • Dogs can be fitted with collars containing insect repellents
  • Local strategies (specific to each community or locality) and community development to eliminate Leishmaniasis should be encouraged

What is the Prognosis of Cutaneous Leishmaniasis? (Outcomes/Resolutions)

  • An early diagnosis and treatment of Cutaneous Leishmaniasis generally results in a good prognosis
  • A delayed treatment or incomplete treatment may lead to disfiguring scars and recurrence of the infection (after a long duration of time)
  • In general, the prognosis of Cutaneous Leishmaniasis is better than other forms of leishmaniasis such as the mucocutaneous and visceral forms

Additional and Relevant Useful Information for Cutaneous Leishmaniasis:

Animals, such as dogs, rats, and cattle, can also be infected by leishmaniasis. According to the World Health Organization, over 70 species of animals act as hosts for the Leishmania organism.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 9, 2016
Last updated: April 15, 2021