title: Chronic cutaneous leishmaniasis, a great mimicker with various clinical presentations: 12 years experience from Aleppo.
abstract: BACKGROUND
  Cutaneous leishmaniasis (CL) has been an endemic disease in Aleppo, Syria for many decades. During the past 12 years, there was a clear increase in the overall incidence of the disease in the region. Treatment using intralesional method of antimonial compounds became ineffective in a considerable proportion of cases and more patients developed the chronic form of the disease.
  
  
  OBJECTIVE
  To categorize chronic cutaneous leishmaniasis (CCL) into different subtypes that mimic a wide spectrum of skin diseases, and to analyse the cause of this increase in the incidence of the disease as a whole and of the chronic type in particular.
  
  
  METHODS
  A total number of 6200 patients with CL were seen in our centre, among which 1880 were initially diagnosed with CCL. Inclusion criteria for CCL included CL for more than 1 year. The diagnosis of CCL was made based on the clinical presentation and a positive Giemsa smear test. Biopsies were performed whenever the Giemsa smear was negative. Patients who had immunosuppression due to a medical condition or intake of immunosuppressive medications were excluded.
  
  
  RESULTS
  Of 1880 patients, 1750 patients fit the inclusion criteria. Based on the lesion morphology, three different types of CCL were defined, among which five subtypes were observed based on clinical pattern and distribution of lesions. The two most common types of CCL were the papulonodular and plaque forms. Around 80% of all CCL cases occurred in individuals under 16 years of age and the most common location was the face (88.6% of cases).
  
  
  CONCLUSIONS
  CCL due to Leishmania tropica can mimic many other dermatological conditions which might lead to a delay in making the correct diagnosis resulting in increased resistance to treatment. We have illustrated eight different clinical presentations of CCL and their differential diagnoses to make physicians more aware of the atypical presentations of CCL. A new treatment plan is suggested for the high-risk group of acute cutaneous leishmaniasis patients to decrease the likelihood of progressing to chronicity.
authors.affiliation: Center for Dermatology Diseases, El Hamdanieh-Aleppo, Syria.
authors.forename: M D
authors.initials: MD
authors.lastname: Douba
authors.forename: O
authors.initials: O
authors.lastname: Abbas
authors.forename: A
authors.initials: A
authors.lastname: Wali
authors.forename: J
authors.initials: J
authors.lastname: Nassany
authors.forename: A
authors.initials: A
authors.lastname: Aouf
authors.forename: M S
authors.initials: MS
authors.lastname: Tibbi
authors.forename: A G
authors.initials: AG
authors.lastname: Kibbi
authors.forename: M
authors.initials: M
authors.lastname: Kurban
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult