Clinical diagnosis of cutaneous leishmaniasis (oriental sore)

Cutaneous leishmaniasis (oriental sore) is characterized by slowly evolving inflammatory lesion(s) that are nodular, noduloulcerative, or ulcerative and that heal spontaneously with scar(s) in 3 to 12 months. In the course of a comprehensive study of cutaneous leishmaniasis due to Leishmania major in an endemic focus in Saudi Arabia, seven clinical features of diagnostic value were identified and their approximate frequency in a selected group of 475 patients was determined. These features were: exposed site location, 84%; pairing or clustering of lesions, 61.72%; skin crease orientation, 35.37%; volcanic nodules, 30.32%; satellite papules, 19.37%; subcutaneous nodules, 11.37%; and "iceberg" nodules, 4.63%. This information should serve the process of clinical diagnosis and may be relied upon when the procedures for parasite detection are negative or unavailable.