Sana RafiqMayo Hospital, Pakistan
Title: Painless, crusted and coalesced papules on right hand
A 25-year-old female, with a travel history to Khyber Pakhtunkhwa, presented with one-year history of erythematous papules coalescing to form an indurated plaque with an overlying crust and scale along with central ulceration on her right hand. The lesion had failed to respond to topical antibiotics and steroids. Dermal scraping for Leishman Donovan bodies was negative but the histopathological examination was suggestive of Cutaneous Leishmaniasis as Leishmania amastigotes could be appreciated along with epidermal hyperkeratosis, lymphocytic infiltrations and plasma cells in the dermis. She was administered intra-lesioned Meglumine antimoniate twice weekly for a month and once weekly subsequently. The induration disappeared and there was complete re-epithelialization after 10 sessions.
Cutaneous Leishmaniasis is a parasitic infection caused by the bite of an infected female sand fly. It manifest as ulcer, crusted papule or plaque on uncovered body surfaces such as face, hands and legs. Diagnosis can be confirmed by visualizing LD bodies under microscope and histopathologic examination of skin smear. Treatment modalities include intralesional antimony injections (localized lesion), thermotherapy, cryotherapy and topical miltefosine.