Post-kala-azar dermal leishmaniasis

Post-kala-azar dermal leishmaniasis (PKDL) is a condition that occurs in some individuals who have been treated for visceral leishmaniasis (VL), also known as kala-azar. It is characterized by a skin rash that appears after the treatment of the visceral form of the disease.

Epidemiology

PKDL is most commonly seen in regions where visceral leishmaniasis is endemic, such as parts of India, Sudan, and Bangladesh. The incidence of PKDL varies by region, with higher rates reported in Sudan compared to the Indian subcontinent.

Pathophysiology

The exact mechanism of PKDL is not fully understood. It is believed to be related to the immune response to the Leishmania parasites that cause visceral leishmaniasis. The condition manifests as a result of the body's attempt to clear residual parasites from the skin.

Clinical Features

PKDL typically presents with a variety of skin lesions, which can include:

• Hypopigmented macules
• Erythematous papules
• Nodules

These lesions usually appear on the face, arms, and upper trunk. The condition can be disfiguring and may persist for several months to years if not treated.

Diagnosis

Diagnosis of PKDL is primarily clinical, based on the appearance of characteristic skin lesions in a patient with a history of visceral leishmaniasis. Laboratory confirmation can be achieved through:

• Skin biopsy
• Polymerase chain reaction (PCR) tests
• Serological tests

Treatment

Treatment of PKDL involves the use of anti-leishmanial drugs. Commonly used medications include:

• Sodium stibogluconate
• Amphotericin B
• Miltefosine

The choice of treatment may vary based on the region and the availability of drugs.

Prognosis

The prognosis for PKDL is generally good with appropriate treatment. However, the condition can be chronic and may require prolonged therapy. Untreated PKDL can serve as a reservoir for the Leishmania parasites, potentially contributing to the spread of visceral leishmaniasis.

Prevention

Preventive measures for PKDL are primarily focused on controlling visceral leishmaniasis through:

• Vector control programs to reduce the population of sandflies
• Early diagnosis and treatment of visceral leishmaniasis
• Health education and awareness campaigns

See Also

• Visceral leishmaniasis
• Leishmaniasis
• Leishmania
• Kala-azar