Overview

Cutaneous leishmaniasis is a skin infection caused by a tiny parasite called Leishmania, which is spread through the bite of an infected female phlebotomine sand fly. It primarily affects the skin, leading to sores. This condition is most common in tropical and subtropical regions of the world, including parts of the Americas, Asia, Africa, and the Middle East. Anyone can get cutaneous leishmaniasis if they are bitten by an infected sand fly in an area where the parasite is found, but it's often seen in those who live in or travel to these regions.

It's important to know that cutaneous leishmaniasis is not contagious from person to person through casual contact like touching. The infection is spread only through the bite of an infected sand fly. Living with skin sores can be distressing, and sometimes the scars left behind can affect self-esteem and quality of life. We understand this can be a challenging experience, and getting the right information is the first step.

Symptoms

Symptoms of cutaneous leishmaniasis usually appear a few weeks or even months after being bitten by an infected sand fly. You might notice:

• Painless skin sores: This is the most common sign. Sores can start as small, raised bumps (papules) or lumps (nodules).
• Ulcers: Over time, these bumps can develop into open sores (ulcers) with a raised border and a crusted, depressed center, sometimes looking like a volcano.
• Multiple lesions: Some people develop only one sore, while others may have many, depending on the number of infective sand fly bites and the type of Leishmania parasite.
• Itching or pain: While often painless, some sores can become itchy or painful, especially if they get infected with bacteria.
• Swollen glands: Lymph nodes near the sores (for example, in the neck if sores are on the face, or in the armpit if sores are on the arm) may become swollen.
• Slow healing: The sores can take months, or even years, to heal on their own.
• Location: Sores typically appear on exposed areas of the body, like the face, arms, and legs, where sand flies are most likely to bite.
• Changes in skin color: After healing, the skin where the sore was may be a different color (lighter or darker) and may have a scar.

Diagnosis

If you have a skin sore that isn't healing, especially if you've lived in or traveled to an area where leishmaniasis is common, a healthcare professional will want to know your travel history and examine the sore carefully.

To confirm cutaneous leishmaniasis, a doctor will usually:

• Take a small sample of tissue from the edge of the skin sore (a skin biopsy or scraping).
• This sample is then examined under a microscope to look for the Leishmania parasites. Sometimes, other specialized tests may be done on the sample.

It's really important to get a proper diagnosis, as other conditions can cause similar-looking skin sores.

Management & Treatment

Dealing with cutaneous leishmaniasis can be a challenging and lengthy process, but there are effective treatments available to help you heal. It's important to work with a healthcare professional to determine the best approach for your specific situation.

Some very small skin sores may heal on their own without any treatment. However, because of the risk of the infection spreading to the mouth or nose, it is always best to have any sore evaluated by a doctor.

Treatment Options

There are several ways to treat cutaneous leishmaniasis, and the best one for you will depend on the type of leishmaniasis you have, where you were infected, and your overall health.

• Topical Treatments: For some types of sores, your doctor may prescribe a medicated cream or ointment to apply directly to the skin. These can include topical paromomycin. In some cases, your doctor may use cryotherapy (freezing) or thermotherapy (heat) to treat the sores.
• Oral Medications: If you have many sores, or if the sores are in a difficult-to-treat location, your doctor may prescribe a medication that you take by mouth. The most common oral medication is miltefosine.
• Intravenous (IV) Medications: In more severe cases, or if the infection is not responding to other treatments, you may need to receive medication through an IV. These can include pentavalent antimonials and amphotericin B.

What to Expect

The timeline for improvement can vary depending on the treatment you receive and how your body responds. It's important to be patient and follow your doctor's instructions carefully. Some treatments may take several weeks to months to fully work, and some sores may leave a permanent scar.

When to See a Doctor

It is always important to see a doctor if you think you have cutaneous leishmaniasis. They can properly diagnose the condition and recommend the best course of treatment. If you have already started treatment and are not seeing any improvement, or if you develop new sores, be sure to follow up with your doctor.

Duration & Outlook

The time it takes for cutaneous leishmaniasis sores to heal can vary greatly. Some sores may heal on their own within a few months, but others can last for a year or even longer. Because of this prolonged duration, it's generally considered a chronic condition for the period the sores are active.

Even after the sores heal, they often leave permanent scars, which can vary in appearance. The outlook is generally good in terms of overall health for most forms of cutaneous leishmaniasis, as it usually only affects the skin.

Warning signs for complications to watch for include:

• Signs of a secondary bacterial infection in the sore, such as increased pain, redness, swelling, warmth, or pus.
• Sores that are very large, numerous, or spreading rapidly.
• In rare cases, with certain types of Leishmania parasites, the infection can spread to the mucous membranes of the nose, mouth, or throat (this is a different form called mucocutaneous leishmaniasis and requires prompt medical attention).

Prevention

The best way to prevent cutaneous leishmaniasis is to protect yourself from sand fly bites, especially if you are in an area where the infection is common. Sand flies are most active from dusk to dawn.

Here are some key prevention tips:

• Avoid outdoor activities - when sand flies are most active (evening and night).
• Wear protective clothing: Cover up with long-sleeved shirts, long pants, and socks. Tuck your shirt into your pants and your pants into your socks for extra protection.
• Use insect repellent: Apply an EPA-registered insect repellent containing DEET, picaridin, oil of lemon eucalyptus (OLE), or IR3535 to exposed skin and under the edges of clothing. Always follow the product instructions.
• Use bed nets: Sleep under a fine-mesh bed net, preferably one treated with an insecticide like permethrin, especially if sleeping quarters are not well screened or air-conditioned.
• Control sand fly populations: If you live in an endemic area, efforts to reduce sand fly breeding sites around your home can help. This includes managing waste and animal shelters.

Causes & Triggers

Causes: Cutaneous leishmaniasis is caused by infection with a microscopic parasite called Leishmania. These parasites are transmitted to people through the bite of infected female phlebotomine sand flies. Sand flies become infected when they bite an animal or person who already has the parasite.

Common Triggers: The primary "trigger" for getting cutaneous leishmaniasis is being bitten by an infected sand fly. There aren't lifestyle triggers in the way we think of for conditions like eczema, but your risk increases with exposure to these insects.

Who is most likely to develop it?

• People living in rural areas of tropical and subtropical countries where the Leishmania parasite and sand flies are present.
• Travelers, tourists, and military personnel visiting these endemic regions.
• Individuals with weakened immune systems may be more susceptible to infection or have more severe disease.

Risk Factors:

• Geographic location: Living in or traveling to known endemic areas.
• Time of day: Being outdoors between dusk and dawn when sand flies are most active.
• Housing conditions: Living in houses with unscreened windows or that are near sand fly breeding sites (e.g., animal burrows, termite mounds, forest areas).
• Occupation: Certain outdoor occupations, like farming or forestry, in endemic areas can increase exposure.
• Malnutrition or weakened immune system: These can increase the risk of developing the disease if exposed.

When to see a doctor

It's important to see a healthcare professional, preferably a dermatologist or a doctor familiar with tropical diseases, if you notice:

• Any skin sore, bump, or ulcer that doesn't heal - within a few weeks, especially if it's slowly getting larger.
• Sores that develop after you've traveled to - or lived in a region where leishmaniasis is known to occur.
• Signs of infection - in a skin sore, such as increasing redness, warmth, swelling, pain, or pus.
• Multiple skin sores - appearing.
• If you are concerned about any new or changing skin lesion.

Getting a timely and accurate diagnosis is key. Even if the sores might eventually heal on their own, seeing a doctor can help confirm what it is and discuss how to care for the sores to prevent secondary infections and minimize scarring.

Frequently Asked Questions (FAQs):

• Is cutaneous leishmaniasis painful? Often, the sores themselves are not painful, especially in the early stages. However, they can become itchy or painful, particularly if they get very large or become infected with bacteria.
• Will cutaneous leishmaniasis sores go away on their own? Many sores from cutaneous leishmaniasis will eventually heal on their own, but this can take many months or even years. Healing often results in a permanent scar.
• How did I get cutaneous leishmaniasis? You likely got it from the bite of an infected sand fly. These tiny flies are found in specific parts of the world, and you might not have even noticed the bite when it happened.
• Can I spread it to my family? No, cutaneous leishmaniasis is not spread from person to person through direct contact like touching, hugging, or sharing items. It is only spread through the bite of an infected sand fly.
• Will I have a scar? Yes, cutaneous leishmaniasis sores typically leave a permanent scar after they heal. The appearance of the scar can vary.
• If I had it once, can I get it again? It depends on the specific Leishmania species. For some types, infection can provide some immunity, but it's possible to get infected again with a different type or if your immunity wanes.

We understand that dealing with skin conditions can be worrying. Remember, this information is to help you understand cutaneous leishmaniasis better, but it’s always best to consult with a healthcare professional for diagnosis and guidance. They are there to help you.

Sources

• American Academy of Dermatology. (n.d.). Leishmaniasis. Retrieved from https://www.aad.org/public/diseases/a-z/leishmaniasis
• Centers for Disease Control and Prevention. (2020, January 14). Leishmaniasis. Retrieved from https://www.cdc.gov/parasites/leishmaniasis/index.html
• World Health Organization. (2021, January 14). Leishmaniasis. Retrieved from https://www.who.int/news-room/fact-sheets/detail/leishmaniasis