Self-administration of herbal treatment for periocular cutaneous leishmaniasis: A case report and systematic review

Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis worldwide, with an estimated annual incidence of 600.000-1 million. Periocular involvement is relatively rare and can be misdiagnosed in cases of atypical presentation. This systematic review comprehensively documents the anatomical distribution, associated ocular involvement, treatment, and outcomes of periocular CL. Databases from MEDLINE and Google Scholar were utilized, and 37 articles have been included over the span of 57 years (1965-2022), with a total of 5945 patients. Three hundred and two patients had periocular CL. Lower eyelid involvement was the most common area affected (39%), and the lateral canthus was rarely involved (6.4%). Conjunctivitis was the most common documented secondary ocular involvement (47.8%). Other serious complications were also noted (periocular ulceration, ankyloblepharon, and preseptal cellulitis). While rare, leishmaniasis is an endemic disease in some areas of the world. Leishmaniasis can be a diagnostic challenge due to the ability to clinically mimic many medical conditions, which can lead to delayed diagnosis and treatment. Physicians need to be watchful for the possibility of CL, especially if the patient presents with any unusual chronic lesions from endemic areas. In addition, we present the first reported case in the English literature of a medial canthal CL masquerading as basal cell carcinoma in an 82-year-old female and the sequela of using herbal treatment.