Heterogeneity of cutaneous leishmaniasis with emphasis on the Old World

Leishmaniasis of the integument which may result from infection with a number of different species of Leishmania can be primary, or can arise as a late manifestation of systemic infection of the reticuloendothelial organs (kala-azar). Infection of the skin and/or mucosae assumes many different clinical forms which are reviewed here. The immune response is essentially a cell-mediated one. Even left untreated, the majority of tegumentary lesions will eventually self-heal but the process may be very prolonged and severe scarring can result. The main features of diagnosis, prevention and treatment are discussed. No vaccines are generally available at present. Organic pentavalent antimonials remain the drugs of choice.