Cutaneous leishmaniasis (CL) is a skin infection caused by a parasite from the Leishmania genus, transmitted to humans through the bite of infected sandflies. Although often overlooked in global health discussions, CL is a significant public health concern, especially in tropical and subtropical regions. It causes disfiguring skin sores and can leave lifelong scars, deeply impacting both the physical and emotional health of those affected.

What Causes Cutaneous Leishmaniasis?

CL is caused by various species of the Leishmania parasite. When a female sandfly infected with the parasite bites a person, it injects the parasite into the skin. The immune system reacts to the invader, and this reaction leads to the formation of ulcers or sores at the site of the bite (Centers for Disease Control and Prevention [CDC], 2023). The disease is considered zoonotic in many areas, meaning it can be transmitted from animals to humans. Reservoir hosts include rodents, dogs, and other mammals.

There are two main forms of CL: Old World CL, found in parts of Africa, Asia, and Europe (mainly caused by L. major, L. tropica, and L. aethiopica), and New World CL, which occurs in the Americas and is caused by species like L. mexicana and L. braziliensis (World Health Organization [WHO], 2024).

Symptoms and Diagnosis

The first sign of CL usually appears a few weeks after the sandfly bite. A small red bump grows into a sore, which may become open and ulcerated. These sores are usually painless, but they can become infected with bacteria, causing additional complications (CDC, 2023). In some people, the sores heal on their own over months, but often they leave behind scars that can be socially stigmatizing.

Diagnosis is confirmed by identifying the parasite in skin samples. This can be done through microscopic examination, culturing, or molecular methods like polymerase chain reaction (PCR). However, access to advanced diagnostic tools is limited in many endemic regions, which makes accurate diagnosis challenging (Reithinger et al., 2007).

Who Is at Risk?

CL mostly affects people living in or traveling to endemic areas with poor housing and sanitation, which provide ideal breeding grounds for sandflies. People involved in outdoor activities such as soldiers, farmers, or eco-tourists are also at higher risk. Outbreaks are often linked to environmental changes like deforestation, urbanization, or war-related displacement, which can expose non-immune populations to infected sandflies (Alvar et al., 2012).

Children and people with weakened immune systems may experience more severe disease or slower healing. While CL is not usually fatal, its psychological and social impact is significant. Disfiguring scars, particularly on visible areas like the face, can lead to anxiety, depression, and social exclusion (Yanik et al., 2004).

Treatment and Prevention

Treatment depends on the Leishmania species and the geographic location. Common treatments include antimonial compounds like sodium stibogluconate, and newer options such as miltefosine or liposomal amphotericin B. Topical treatments and cryotherapy are sometimes used for mild cases. However, side effects, cost, and drug resistance are ongoing concerns (Pace, 2014).

There is currently no vaccine for CL, so prevention focuses on avoiding sandfly bites. Measures include using insect repellent, sleeping under insecticide-treated nets, and wearing protective clothing. Community-level strategies such as improving housing and waste management also help reduce sandfly populations (WHO, 2024).

The Need for Greater Awareness

Despite affecting an estimated 600,000 to 1 million people annually, CL remains a neglected tropical disease (WHO, 2024). Limited funding and low public awareness hinder efforts to control and treat the disease. Raising awareness, strengthening surveillance systems, and investing in research for vaccines and better diagnostics are essential steps to reduce the burden of this preventable disease.

Governments and health organizations must prioritize CL not only as a medical issue but also as a social and economic challenge. Individuals with visible scars often face stigma, impacting their education, employment, and mental health. Holistic care that addresses both the physical and psychological aspects of CL is necessary for truly effective treatment and rehabilitation (Yanik et al., 2004).

Cutaneous leishmaniasis is more than just a skin condition it’s a disease that touches nearly every part of a person’s life, especially in resource-poor settings. Though rarely fatal, its emotional and societal impact is profound. With improved diagnosis, treatment, prevention strategies, and global attention, CL could become a disease of the past. Until then, education and empathy remain powerful tools in managing its burden.

References

  1. Alvar, J., Vélez, I. D., Bern, C., Herrero, M., Desjeux, P., Cano, J., … & WHO Leishmaniasis Control Team. (2012). Leishmaniasis worldwide and global estimates of its incidence. PLoS ONE, 7(5), e35671. https://doi.org/10.1371/journal.pone.0035671
  2. Centers for Disease Control and Prevention. (2023). Cutaneous leishmaniasis. https://www.cdc.gov/parasites/leishmaniasis/gen_info/faqs.html
  3. Pace, D. (2014). Leishmaniasis. Journal of Infection, 69(S1), S10–S18. https://doi.org/10.1016/j.jinf.2014.07.016
  4. Reithinger, R., Dujardin, J. C., Louzir, H., Pirmez, C., Alexander, B., & Brooker, S. (2007). Cutaneous leishmaniasis. The Lancet Infectious Diseases, 7(9), 581–596. https://doi.org/10.1016/S1473-3099(07)70209-8
  5. World Health Organization. (2024). Leishmaniasis. https://www.who.int/news-room/fact-sheets/detail/leishmaniasis
  6. Yanik, M., Gurel, M. S., Simsek, Z., & Kati, M. (2004). The psychological impact of cutaneous leishmaniasis. Clinical and Experimental Dermatology, 29(5), 464–467. https://doi.org/10.1111/j.1365-2230.2004.01525.x

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