Cutaneous Leishmaniasis
A parasitic skin infection spread by sand fly bites
Quick Facts
- Type: Parasitic skin infection
- Spread by: Bites of infected sand flies
- Typical sign: A slow-healing sore or ulcer
- Where it occurs: Parts of the tropics, Middle East, and beyond
Overview
Cutaneous leishmaniasis is an infection of the skin caused by tiny parasites called Leishmania. The parasites are spread to people through the bite of infected female sand flies, small insects that are active mainly at dusk and night. After a bite, the parasites multiply in the skin and produce one or more sores.
The disease is found in many parts of the world, including parts of the Middle East, Central and South America, North and East Africa, and Central and South Asia. It is the most common form of leishmaniasis. Sores often heal slowly over months, sometimes on their own, but they can leave scars, and treatment is used to speed healing and reduce complications.
Symptoms
Symptoms usually appear weeks to months after an infected sand fly bite, often on exposed skin such as the face, arms, or legs. They include:
- A skin sore that begins as a small bump and slowly enlarges.
- An open ulcer with a raised border, often painless unless it becomes infected with bacteria.
- One or several sores at sites of bites.
- Swollen nearby lymph nodes in some cases.
- Scarring after the sore heals.
The sores are typically not painful on their own. In some forms, sores near the nose or mouth can affect those tissues, which needs specific evaluation.
Causes
Cutaneous leishmaniasis is caused by several species of the Leishmania parasite. People become infected when bitten by a sand fly that is carrying the parasite. The sand fly picks up the parasite when it feeds on an infected person or animal, such as rodents or dogs, and then passes it on with later bites.
The disease is not spread directly from person to person through casual contact. It is tied to where infected sand flies live, so risk is highest in or near regions where the disease is common, especially in rural and outdoor settings.
Risk Factors
- Living in or traveling to areas where leishmaniasis is common
- Outdoor activities at dusk and night when sand flies feed
- Sleeping outdoors or in poorly screened housing
- Limited use of insect repellent or protective clothing
- A weakened immune system, which can lead to more severe or widespread disease
Diagnosis
Diagnosis is based on the appearance of the sore, travel or residence history, and laboratory tests.
- Travel and exposure history: Whether you have been in an area where the disease occurs.
- Sample from the sore: A scraping, smear, or small biopsy examined under a microscope to find the parasite.
- Specialized tests: Culture or molecular tests that can confirm infection and identify the species, which can guide treatment.
Identifying the parasite is important because management can differ depending on the species and the region where it was acquired.
Treatment
Some sores heal on their own over months, but treatment is often used to speed healing, reduce scarring, and lower the risk of complications. The choice depends on the species, the number and location of sores, and the person's health.
- Local treatments: Such as injections into the sore, heat or cold therapy, or topical agents for limited disease.
- Systemic medications: Antiparasitic medicines taken by mouth or given by injection for more extensive disease, certain species, or sores near the nose or mouth.
- Wound care: Keeping the sore clean and treating any added bacterial infection.
Because treatment varies and some drugs have side effects, care is best guided by a clinician familiar with the disease.
Prevention
There is no vaccine, so prevention focuses on avoiding sand fly bites, especially when in areas where the disease occurs:
- Use insect repellent on exposed skin
- Wear long sleeves and long pants, especially from dusk to dawn
- Sleep under fine-mesh, insecticide-treated bed nets
- Stay in well-screened or air-conditioned areas when possible
- Avoid outdoor activities at peak sand fly times when feasible
When to See a Doctor
See a doctor if you develop a slow-healing skin sore, particularly after traveling to or living in an area where leishmaniasis occurs. Seek prompt care if you have:
- A sore that is enlarging, not healing, or scarring badly
- Sores on or near the nose, mouth, or lips
- Signs of added bacterial infection, such as increasing pain, redness, warmth, pus, or fever
- Multiple or widespread sores, especially if your immune system is weakened
Frequently Asked Questions
How do people get cutaneous leishmaniasis?
People get it from the bite of an infected female sand fly, a small insect active mainly at dusk and night. The disease is not spread directly from person to person through casual contact.
What does a leishmaniasis skin sore look like?
It usually starts as a small bump that slowly grows into an open ulcer with a raised border. The sores are often painless on their own and may appear singly or in groups on exposed skin such as the face, arms, or legs.
Where does cutaneous leishmaniasis occur?
It is found in many warmer regions, including parts of the Middle East, Central and South America, North and East Africa, and Central and South Asia. Risk is highest for people living in or traveling to these areas.
Does cutaneous leishmaniasis go away on its own?
Some sores heal on their own over months, but treatment is often used to speed healing, reduce scarring, and prevent complications. Sores near the nose or mouth and more extensive disease usually need treatment.
How can I prevent cutaneous leishmaniasis when traveling?
There is no vaccine, so prevention means avoiding sand fly bites. Use insect repellent, wear long sleeves and pants, sleep under insecticide-treated bed nets, and limit outdoor activity from dusk to dawn in affected areas.
References
- Centers for Disease Control and Prevention (CDC). Leishmaniasis.
- World Health Organization (WHO). Leishmaniasis.
- MedlinePlus, U.S. National Library of Medicine. Leishmaniasis.
- National Institute of Allergy and Infectious Diseases (NIAID).