Unmasking and managing cutaneous leishmaniasis in South India

This issue of the Journal of Skin and Sexually Transmitted Diseases presents varied topics in dermatology and sexually transmitted diseases, especially of importance to the region.

A case series on cutaneous Leishmaniasis by Shailaja et al.^[1] is important in various aspects as far as this region is concerned.

Cutaneous leishmaniasis (CL) poses significant challenges in diagnosis and treatment. Although common in some parts of the country, this disease is not considered widely prevalent in South India.

This study’s highlights include the following:

1. Out of 16 cases detected, 15 were from the tribal community, a socially disadvantaged section of the community. It is highly likely that there are far more active, yet undetected cases in this area.

2. Most of these cases presented as plaques and nodules, which can mimic Hansen’s disease. This clinical overlap can lead to misdiagnosis and delayed treatment.

3. The apparent low awareness about the disease among healthcare providers and the public may result in a low index of suspicion about CL, which can contribute to misdiagnosis.

4. Variable parasite load: Only nine out of 16 cases showed the classical Leishman-Donovan bodies. All these cases were diagnosed in the research laboratory using polymerase chain reaction (PCR). This highlights the need for easy access to PCR or more sensitive and specific point-of-care tests to address the problem.

5. This study does not mention the species.

6. This study also confirms the presence of Phlebotomus argentipes in the colonies, which suggests the possibility of undetected cases and carriers in the region.

7. Authors used easily available and less expensive drugs like fluconazole with varied success, an important aspect that needs to be explored in detail.

The study highlights different but interconnected challenges in the management of CL, especially in a low-prevalence scenario. This calls for a multipronged approach, which includes strengthening diagnostic capacity at peripheral levels and implementing community-based awareness and control programs.

Also included in this issue is a comprehensive review of the use of silver in dermatology, which describes the evolution of silver as a therapeutic agent – from ancient China to the era of nanotechnology. It reviews silver as a versatile agent with roles in infection control, wound healing, and general skin care.

Another interesting study in this issue is related to medical education in the context of dermatology by Kaliyadan et al.^[2] The study explores the challenges in the assessment of dermatology at the undergraduate level. The study focuses on script concordance tests for the assessment of clinical reasoning skills.

With review articles, original studies, Quizzes, and case reports, I hope the current issue of the journal will be an enriching experience for the readers.