CUTANEOUS LEISHMANIAOIS

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CUTANEOUS LEISHMANIASIS

Caused by a protozoa calledleishmania

Pathogenesis:

The vector host is a sandfly

PHLEBOTOMUS.

The disease is transmitted to the humanbeings by the bite of the infected sandfly.


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Primary reservoir can be humans orcertain animals


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Life cycle


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CLINICAL FEATURES

The disease can present to thedoctor in our part of the worldin a variety ofways

INCUBUTION PERIOD 3WEEKS TO 3 MONTHS

STARTS AS INSECT BITE LIKERASH

1. A nodule or nodules onExposed parts of the body.

2. An ulcer or ulcers on theexposed parts of the body.

3. Dry psoriasiform plaque orplaques.


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Always examine the ulcer to checkfor induration

4.SubcutaneusNodules and ulcers inlinear chains.

relapse of the disease

in a previously healedscar known asleishmaniasisrecidivans

Dessiminatedleishmaniasis

Postkalazar dermalleishmaniasis


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DESSIMINATED LEISHMANIASIS

Clinically thedisease presents as

multiple papulesand plaques onvarious parts of thebody

IT is very resistantto treatment


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DIAGNOSIS

Clinical Smear Examination: Skin Biopsy. Culture

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


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TREATMENT

PHYSICAL THERAPY

CRYOTHERAPY. Local heat therapy.

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


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LYMPHATIC SPREAD INLEISHMANIASIS

Such pathology can also be seen inSPOROTRICOSIS,MYCOBACTERIALINFECTIONS


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This can be misdiagnosed ifpalpation to feel dermal

pathology is not done

PSORIASIFORM SKIN LESION


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PSORIASIFORM SKINPATHOLOGY ON COVERED

AREAAlways take skin biopsy from such

atypical skin lesions


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Intralesional glucantime does notwork as the disease has spread

through lymphatics


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Leishmaniasis simulating cellulitis


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Leishmaniasis simulating sacoidosis


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Leishmaniasis simulating basal cellcarcinoma


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Awarenes about this disease islacking


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ANNULAR SKIN LESION INLEISHMANIASIS

SIMILAR PATHOLOGY CAN BE SEEN INGRANULOMA

ANNULARAE,LEPROSY,FUNGAL

INFECTIONS,LICHENPLANUS,TUBERCULOSIS.


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Staph aureus and streptococalskin infections may have

similar pictureAlways take history and do clinical

examination


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LEISHMANIASIS SIMULATING DLE


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Steroid modified leishmaniasis


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HIV +,has developed nodules on theskin and oral mucosa,

5 hi t h i


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5 years history,chronicgranulomatous inflamation,pas stain

+


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Many diseases can have such likepresentation

LICHEN PLANUS

PSORIASIS

EPIDERMAL NEVUS LICHEN STRIATICUS


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Chronic swelling of the legs

Gets recurrent fever with increase inswelling,pain and erythema.

Good response to penicillins


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PRURITUS,FAMILYHISTORY +

PRURITIC NODULES ON

GENITALIA ARE DIAGNOSTIC


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Family history +parents first cousins

Similar rash in perioral region,oralthrush,decrease hair growth


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Short history,fresh ulcers,unfreindlyfamily envirnoment


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Small skin lesion usedclobavate

Steroids are not the answer for

every skin rash


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ACNAE VULGARIS

Teen age

Polymorphic skin rash

Papules,pustules,nodules,comedones/

Face,chest,back can beinvolved

There is follicularplugging,increased sebumproduction and increasein the no ofpropianibacterium acnae

Treatment includes

Tetracyclines

macrolides

Clindamycin Synthetic vitamin a

derivatives

Benzyle peroxide


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ACNE ROSACIA

Midle age,usuallyfemales,fair color

There are papules andpustules

with,telangiactasia,erythema,

Central part of face isinvolved

Complain of burning andeye irritation

Tetracyclines andmetronidazole are given

CUTANEOUS LEISHMANIAOIS

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