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CUTANEOUS LEISHMANIASIS

Caused by a leishmania Pathogenesis: protozoa called

The vector host is a sandfly PHLEBOTOMUS. The disease is transmitted to the human beings by the bite of the infected sandfly.

Primary reservoir can be humans or certain animals

Life cycle

CLINICAL FEATURES

The disease can present to the doctor in our part of the world in a variety of ways INCUBUTION PERIOD 3 WEEKS TO 3 MONTHS STARTS AS INSECT BITE LIKE RASH 1. A nodule or nodules on Exposed parts of the body. 2. An ulcer or ulcers on the exposed parts of the body. 3. Dry psoriasiform plaque or plaques.

Always examine the ulcer to check for induration

4.Subcutaneus

Nodules and ulcers in linear chains. relapse of the disease in a previously healed scar known as leishmaniasis recidivans Dessiminated leishmaniasis Postkalazar dermal leishmaniasis

DESSIMINATED LEISHMANIASIS
Clinically the disease presents as multiple papules and plaques on various parts of the body IT is very resistant to treatment

DIAGNOSIS

Clinical

Smear Examination: Skin Biopsy. Culture

DIFERENTIAL DIAGNOSIS Syphilis ,deep mycosis, cutaneous tuberculosis, Leprosy, Psoriasis ,skin tumors, dermatitis artifacta, pyoderma gangrenosum.

TREATMENT
PHYSICAL THERAPY

DRUG THERAPY

CRYOTHERAPY. Local heat therapy.

SODIUM STIBOGLUCONATE MEGLUMINE ANTIMONATE. Ketoconazole Itraconazole Dapsone Rifampicin Allopurinal. Amphoterin B.

LYMPHATIC SPREAD IN LEISHMANIASIS

Such pathology can also be seen in SPOROTRICOSIS,MYCOBACTERIAL INFECTIONS

This can be misdiagnosed if palpation to feel dermal pathology is not done


PSORIASIFORM SKIN LESION

PSORIASIFORM SKIN PATHOLOGY ON COVERED AREA


Always take skin biopsy from such atypical skin lesions

Intralesional glucantime does not work as the disease has spread through lymphatics

Leishmaniasis simulating cellulitis

Leishmaniasis simulating sacoidosis

Leishmaniasis simulating basal cell carcinoma

Awarenes about this disease is lacking

ANNULAR SKIN LESION IN LEISHMANIASIS

SIMILAR PATHOLOGY CAN BE SEEN IN GRANULOMA ANNULARAE,LEPROSY,FUNGAL INFECTIONS,LICHEN PLANUS,TUBERCULOSIS.

Staph aureus and streptococal skin infections may have similar picture
Always take history and do clinical examination

LEISHMANIASIS SIMULATING DLE

Steroid modified leishmaniasis

HIV +,has developed nodules on the skin and oral mucosa,

5 years history,chronic granulomatous inflamation,pas stain +

Many diseases can have such like presentation


LICHEN PLANUS PSORIASIS EPIDERMAL NEVUS LICHEN STRIATICUS

Chronic swelling of the legs


Gets recurrent fever with increase in swelling,pain and erythema. Good response to penicillins

PRURITUS,FAMILY HISTORY +
PRURITIC NODULES ON GENITALIA ARE DIAGNOSTIC

Family history +parents first cousins

Similar rash in perioral region,oral thrush,decrease hair growth

Short history,fresh ulcers,unfreindly family envirnoment

Small skin lesion used clobavate


Steroids are not the answer for every skin rash

ACNAE VULGARIS
Teen age Polymorphic skin rash Papules,pustules,nodules, comedones/ Face,chest,back can be involved There is follicular plugging,increased sebum production and increase in the no of propianibacterium acnae

Treatment includes Tetracyclines macrolides Clindamycin Synthetic vitamin a derivatives Benzyle peroxide

ACNE ROSACIA

Midle age,usually females,fair color There are papules and pustules with,telangiactasia, erythema, Central part of face is involved Complain of burning and eye irritation Tetracyclines and metronidazole are given