Systematic review on the epidemiology, diagnostics and management of leishmaniasis recidivans

One of the most severe and least understood forms of cutaneous leishmaniasis (CL) is leishmaniasis recidivans (LR), a chronic variant in which lesions reappear months or years after apparent healing. This review aimed to consolidate fragmented information to clarify LR's epidemiological scope, diagnostic methods, and treatment strategies.

A comprehensive literature search according to PRISMA guidelines was conducted across multiple databases, with the final search completed on November 15, 2025. Risk of bias was assessed using JBI checklists. A study protocol for this review was registered with OSF (10.17605/OSF.IO/6NFT3). Data were synthesized narratively as meta-analysis was not feasible.

Forty-three papers were included, thirty-two from the Old World and eleven from the New, representing seventeen countries. LR primarily affected children, and factors such as trauma, immunosuppression, or irregular treatment were stated as triggers. Cases tended to be geographically restricted, with L. tropica most frequently reported. Both the lesion morphology and the latency period varied widely. Microscopy and histology gave poor accuracy, limited by low parasite loads and overlapping diagnoses. Isoenzyme analysis identified distinct LR strains. Pentavalent antimonials (PA) were the main treatment, and combination regimens showed promise in overcoming LR persistence.

LR remains modestly recognized, with considerable overlap with classical CL. The evidence points to species-level differences in recurrence, compounded by the role of host factors and parasite diversity. Consistent adherence to therapy is a decisive element in managing LR. Without broader, more systematically coordinated data, both clinical guidance and effective public health strategies will not be possible.