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Cutaneous leishmaniasis (oriental sore) is an infective granulomatous lesion of the skin and subcutaneous tissues causing either a papular lesion which ulcerates later on (Dry type) or one with early kind (MOIST Type).

Cutaneous leishmaniasis is caused by L. tropica and L. major. L. tropica is endemic in India, urban areas of Pakistan, Mediterranean region, USSR, Afghanistan, Africa, Sudan etc. It generally involves children and young adults. The principal reservoirs are human and vectors are sand flies (P. papatasi in Indian subcontinent and P. sargenti in other regions).

L. Major causes moist lesion and is endemic in rural and desert areas of the Middle East, Sudan, Ethiopia. Nigeria and Africa. The reservoir is maintained in burrowing wild rodents. Vectors are B. caucasicus and P. papatosi which feed on these infected rodents and transmit the disease to humans.

Clinical picture

The incubation period for the ‘dry type’ ranges from 2 to 6 months. It is a small red papule on the face which gradually enlarges and ulcerates. Ulceration is mainly confined to the central region and it has well defined rounded edges with a granulation tissue base exuding thin pus.

The sores may be single or multiple and are present on exposed parts of body. Lymph glands are usually not enlarged. Healing occurs in 1-2 years and leaves behind a de-pigmented patch. The parasites are in abundance and spread occurs by transmission due to personal contact with an infected person. Even auto inoculation also occurs but through a broken skin.

L. major which causes ‘moist type’ of lesion has an incubation period of 2 to 6 weeks. They are multiple and are generally present on lower extremities. After the formation of a pruritic papule, ulceration takes place in 2 weeks. Lymphangitis is common. Healing with scarring takes place within 2 to 6 months. The number of parasites in it is generally scanty.


It is made by demonstrating the parasite in smear made from scrapings from the ulcer margin. Further inoculation can be done on NNN media. A biopsy taken from the depth of it shall show atrophy of the epidermis and infiltration with lymphocytes and plasma cell and Macrophages containing L Tropica. When infection supervenes, there may be predominance of degenerative and destructive changes.

Treatment of Cutaneous leishmaniasis

When the sores are few, local treatment is instituted. It consists of intra lesional injection of antimony compound (sodium stibogluconate lOOmg/ml) or Mepacrine Hydrochloride (100 mg dissolved in 2 ml of distilled water).

Infiltration is done at intervals of 3 days and generally about 6-8 sittings are required. This however is a painful procedure. Many times they are secondarily infected and tend to become chronic. Such cases require antibiotic therapy in addition to antimony therapy.

When they are too numerous and not liable to respond to local infiltration, sodium aurothiomalate in the dose of 20 mg IIM every alternate day (total dose 250 rug) is administered. Another trivalent antimony compound stibophen (Fuadin) is administered as a 6.4 per cent solution by intramuscular route.

Approximately 3 to 5 ml of the drug is given on alternate day for 8 to 10 injection. Sodium antimony gluconate administered intravenously in the dose of 600mg daily for 10 days is particularly useful for treating multiple. Recently ketoconazole in the dose of 200-400/day for 4-6 weeks has also been found to give good results.


Measure be adopted to prevent bite by sand fly. Its breeding grounds be eradicated by DDT spraying. Use of repellants on parts exposed after sunset be encouraged. Mosquito nets be used at night. Ulcers should always be kept covered so that infection does not spread. Personal contact with an infected person be avoided.



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