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Post-kala-azar dermal leishmaniasis: a global overview
Chaitali Ghosh1, Chaitali Karmakar1, Deblina Sarkar1
1Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India.
Clinical and Experimental Dermatology
|January 8, 2026
Summary
Post-kala-azar dermal leishmaniasis (PKDL) is a persistent skin complication after visceral leishmaniasis (VL) treatment. Addressing PKDL requires integrated diagnostics, immunology, and community strategies for kala-azar elimination.
Area of Science:
- Dermatology
- Infectious Diseases
- Immunology
Background:
- Post-kala-azar dermal leishmaniasis (PKDL) is a chronic skin sequela in patients treated for visceral leishmaniasis (VL).
- PKDL poses a significant epidemiological challenge in South Asia, acting as a reservoir for Leishmania donovani and sustaining VL transmission.
- Risk factors include prior VL, immunosuppression, host genetics, malnutrition, and delayed diagnosis due to stigma and poor health-seeking behavior.
Purpose of the Study:
- To review the epidemiological challenges, diagnostic difficulties, and therapeutic hurdles of PKDL.
- To highlight the immunological aspects and the role of molecular tools in PKDL diagnosis.
- To emphasize the need for integrated strategies for PKDL elimination and sustained VL control.
Main Methods:
- Literature review and synthesis of current knowledge on PKDL.
- Analysis of diagnostic challenges, including molecular tools.
- Evaluation of therapeutic management and its limitations.
Main Results:
- PKDL presents as macular or polymorphic forms, with diagnostic challenges in early or macular stages due to low parasite burden.
- The disease involves a mixed Th1/Th2 immune response with significant cellular infiltration.
- Current treatments are hampered by prolonged duration, relapse risk, drug resistance, and poor compliance.
Conclusions:
- Molecular diagnostics offer improved sensitivity and field applicability for PKDL detection.
- Understanding the immunological profile is crucial for managing PKDL.
- Integrated strategies combining molecular diagnostics, immunological insights, and community-based treatment are essential for PKDL elimination and overall kala-azar control efforts.
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