Current status of cutaneous leishmaniasis in Aleppo, Syrian Arab Republic

Cutaneous leishmaniasis has been endemic in Aleppo, Syria, for generations. Recently there has been a clear increase in the incidence of the disease, and more patients have shown a lack of response to antimonials. We report the results of a survey, undertaken over the period 2-17 January 1995, at a general hospital in Aleppo, of all patients presenting with cutaneous leishmaniasis. Patients were grouped according to the stage of their disease, and surgical biopsies were carried out for histopathological investigation. Patients who were unresponsive to treatment and proceeded to chronicity were predominantly children aged under 15 years with facial lesions. Histopathological examination showed that the inflammatory changes had reached the upper layers of the subcutaneous tissues in 10 of the 25 chronic cases (40%) and three of the four acute cases (75%). These levels of the skin are not directly reached by the antimonials administered intralesionally. The inadequacy of the intralesional method alone and technical errors in administration are discussed.