DermDx: Papulopustular Rash on Pinkie Finger

Cutaneous leishmaniasis is an infection caused by the flagellated Leishmania parasite. It is a zoonotic disease transmitted by the bite of bloodsucking Phlebotomus sandflies.1  Reservoirs of the disease are found in wild or semi-domesticated animals including rodents and dogs. The...

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Cutaneous leishmaniasis is an infection caused by the flagellated Leishmania parasite. It is a zoonotic disease transmitted by the bite of bloodsucking Phlebotomus sandflies.¹  Reservoirs of the disease are found in wild or semi-domesticated animals including rodents and dogs. The disorder is found in North and South America, ranging from Texas to Argentina, and in the Middle East and North Africa. It is endemic in 88 countries.² The World Health Organization has designated leishmaniasis as a neglected tropic disease.³

Three clinical forms of leishmaniasis are identified: cutaneous, mucosal, and visceral. Cutaneous leishmaniasis begins as an inflamed papule at the site of a sandfly bite and evolves into a painless nodule or plaque that crusts and ulcerates. Secondary infection, immunosuppression, or inappropriate treatment may alter the clinical appearance and the condition may resemble a multitude of skin disorders.⁴

Cutaneous leishmaniasis should be considered in the differential of any nonhealing skin lesion arising in a resident of an endemic area or in an individual who has recently visited an endemic area. Common dermoscopic findings include vascular structures, yellow tears, and white starburst-like pattern.⁵ Diagnosis is confirmed with the identification of amastigotes by microscopic examination of a tissue biopsy or skin scraping. Culture and polymerase chain reaction (PCR) testing may be used to confirm the diagnosis and identify the species.⁶

Most cases of cutaneous leishmaniasis resolve spontaneously. Systemic therapy is indicated for larger or multiple lesions and lesions on the hands and feet, face, or joints.⁷ Pentavalent antimonials such as sodium stibogluconate and meglumine antimoniate are the most commonly prescribed treatment and are the first-line treatment in many parts of the world but are not available in the US. Alternative therapies include miltefosine, fluconazole, itraconazole, paromomycin, heat therapy, and topically applied cryotherapy.³

Nejib Doss, MD, is a dermatologist at Hospital Militaire and Golden Towers Medical Center, both in Tunis, Tunisia;

Ibrahim Al Mukkahal, MD, is head of the Dermatology Department at Benghazi Medical Centre in Benghazi, Libya;

Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Mokni M. Cutaneous leishmaniasis. Ann Dermatol Venereol. 2019;146(3):232-246. doi:10.1016/j.annder.2019.02.002

2. Markle WH, Makhoul K. Cutaneous leishmaniasis: recognition and treatment. Am Fam Physician. 2004;69(6):1455-1460.

3. de Vries HJC, Schallig HD. Cutaneous leishmaniasis: a 2022 updated narrative review into diagnosis and management developments. Am J Clin Dermatol. 2022;23(6):823-840. doi:10.1007/s40257-022-00726-8

4. Gurel MS, Tekin B, Uzun S. Cutaneous leishmaniasis: a great imitator. Clin Dermatol. 2020;38(2):140-151. doi:10.1016/j.clindermatol.2019.10.008

5. Serarslan G, Ekiz Ö, Özer C, Sarıkaya G. Dermoscopy in the diagnosis of cutaneous leishmaniasis. Dermatol Pract Concept. 2019 ;9(2):111-118. doi:10.5826/dpc.0902a06

6. Ngan V, Wootton C. Leishmaniasis. DermNet. Updated January 2017. Accessed April 17, 2023. https://dermnetnz.org/topics/leishmaniasis

7. Adame S, Korman AM. Spreading painful lesions on the legs. Cutis. 2023;111(3):159,164. doi:10.12788/cutis.0725