Cutaneous leishmaniasis

Overview

Cutaneous leishmaniasis is the most common form of leishmaniasis. It is caused by tiny parasites (living things that live on or in another body) called Leishmania. They are passed to people by the bite of an infected female sandfly. Sandflies are much smaller than mosquitoes, and their bite is often painless, so many people never notice it. They bite most from dusk to dawn.

In Pakistan and nearby countries, two types cause most skin disease. Leishmania tropica passes mainly from person to person through sandflies. Leishmania major passes to people from animals such as gerbils and other rodents. A small bump (papule) usually appears weeks or months after the bite. It slowly grows into a lump or flat raised patch, and often becomes an ulcer (open sore) with a crust and a raised edge. The sores are often painless.

Many sores heal on their own, but this can take months or more than a year, and it usually leaves a sunken scar. Sores on the face can cause lasting marks. Not everyone who is bitten becomes ill. Untreated sores can pass the parasite to new sandflies for months, so covering them helps protect others.

Symptoms

• A small, firm bump on the skin where a sandfly bit, appearing weeks or months later
• A bump that slowly grows into a lump or a raised round or oval patch
• An open sore (ulcer) with a crust in the middle and a raised, red or dark edge
• Sores that are often painless
• Sores on uncovered skin such as the face, neck, arms or legs
• One sore or several sores, sometimes with small new bumps around the first one
• Usually no fever and feeling otherwise well
• A sore that lasts for months and heals with a sunken scar

Causes and risk factors

Causes

• Infection with Leishmania parasites, mainly Leishmania tropica and Leishmania major in Pakistan
• The bite of an infected female sandfly, which carries the parasite from one person or animal to another
• Leishmania tropica, which spreads mainly from infected people to others through sandflies
• Leishmania major, which spreads from rodents such as gerbils to people through sandflies
• Rarely, blood transfusion, shared contaminated needles, or from mother to baby during pregnancy or birth

What makes it more likely

• Living in or travelling to an area where the disease is common, especially rural areas
• Sleeping outdoors or not using a bed net, especially from dusk to dawn
• Not using insect repellent
• Living in a mud-built house, or near rubble, rubbish, animal shelters or plants where sandflies rest
• Keeping domestic animals close to the home
• Low household income
• Being a child, or spending a lot of time outdoors
• A weak immune system, for example from HIV, or poorly controlled diabetes, which can make the disease harder to treat

Complications

The most common lasting problem is scarring. Sores often heal with a sunken scar, and scars on the face can leave lasting marks. Some sores, especially from Leishmania tropica, last a long time or come back in or around an old scar years later (lupoid or recidivans leishmaniasis). Sores near the eyes, nose, lips, ears, fingers, toes or joints can cause more damage and are harder to treat. A sore can also get a germ (bacterial) infection, with spreading redness, swelling and pain. Rarely, some types spread to the lining of the nose, mouth or throat (mucosal leishmaniasis), which can damage these areas.

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Diagnosis

Your doctor will look at the sore and ask where you live, where you have travelled and how long the sore has been there. Doctors in areas where the disease is common can often suspect it by looking. But many other skin problems can look similar, such as germ infections of the skin, warts, skin tuberculosis and skin cancer, so a test is needed before medicine is started.

The usual test is a skin sample. After numbing the area, a health worker scrapes the edge of the sore and looks at the sample under a microscope for the parasite. A small piece of skin (biopsy) may be taken if the first test is negative or another illness is possible. Where available, a culture or a DNA test (PCR) is more sensitive and can show the exact type of parasite, which can help choose treatment. Blood antibody tests are not useful for the skin form, and there is no quick rapid test.

Treatment

1. See a doctor so the sore can be tested and the type, size, number and place of the sores can be checked
2. Keep every sore clean: wash it with clean water and soap and cover it with a gauze dressing held by tape, changing it a few times a week
3. For a few small sores that are not on the face, fingers or toes, in a healthy person, the doctor may advise careful wound care and regular check-ups instead of medicine, because many sores heal on their own
4. If treatment is needed for a few small sores, the doctor may use treatment on the sore itself, such as freezing it (cryotherapy), injecting antimony medicine into the sore, local heat treatment, or paromomycin ointment where available
5. For large sores, four or more sores, sores in difficult places, or a weak immune system, the doctor may give medicine into a muscle or vein, usually a pentavalent antimony medicine; other options are chosen by a specialist
6. If the sore gets a germ infection, the doctor may prescribe an antibiotic
7. Go back for check-ups so the doctor can confirm healing and look for any sore that returns; your doctor decides every medicine and dose

Medicines in Pakistan

Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Also used (not yet in our price list): Sodium stibogluconate (pentavalent antimony medicine), Paromomycin ointment (applied to the sore)

Self-care and prevention

Self-care

• Wash sores gently with clean water and soap, and keep them covered with a clean gauze dressing
• Change the dressing a few times a week so a sticky crust does not build up
• Keep sores covered and sleep under an insecticide-treated bed net, so sandflies cannot pick up the parasite and pass it to others
• Do not put iodine, antibiotic ointments or other creams on the sore unless a doctor advises it, because some can cause a skin allergy
• Go to every follow-up visit, even if the sore looks better
• Tell your doctor if you are pregnant, could become pregnant, are breastfeeding, or have heart, liver or kidney problems before any treatment
• Return to the doctor if the sore gets bigger, becomes red and painful, or comes back after healing

Prevention

• Sleep under an insecticide-treated bed net, especially from dusk to dawn when sandflies bite most
• Use insect repellent, especially in the evening and at night
• Avoid sleeping outdoors where sandflies are common
• Remove rubble and rubbish heaps and fill cracks in walls near the home, where sandflies breed and rest
• Get sores checked and treated early, and keep them covered, so the infection does not spread to others
• Remember that having had the disease does not fully protect you, and there is no vaccine yet

Common questions

Is cutaneous leishmaniasis contagious?

It does not spread like a cold. It mainly spreads when a sandfly bites an infected person or animal and then bites someone else. Rarely it spreads through blood transfusion or shared needles. Keeping sores covered and using bed nets helps stop sandflies from passing it on.

Will the sore go away without treatment?

Many sores heal on their own, but this can take months or more than a year and often leaves a scar. Some sores, especially from Leishmania tropica, last longer or come back. A doctor should check every sore to decide if treatment is needed.

Why are injections used for this sore?

Antimony medicines are the main treatment in the region. For a few small sores they can be injected into the sore itself, sometimes with freezing. For larger or many sores they may be given into a muscle or vein. Your doctor decides which approach is right for you.

Can it be treated in pregnancy?

WHO guidance says antimony injections into a muscle or vein must not be used in pregnancy, and miltefosine must not be used in pregnancy. Azole tablets are generally not recommended either. Some sores can wait until after the baby is born. Always let your doctor decide.

Will I have a scar?

Many sores heal with a sunken scar. Sores on the face can leave lasting marks, so it is worth seeing a doctor early about any sore on the face.

Sources

1. World Health Organization Regional Office for the Eastern Mediterranean (WHO EMRO). Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region (2014).
2. World Health Organization Regional Office for the Eastern Mediterranean (WHO EMRO). Cutaneous leishmaniasis factsheet (n.d.).
3. Infectious Diseases Society of America (IDSA) and ASTMH, Clinical Infectious Diseases. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH) (2016).
4. Centers for Disease Control and Prevention (CDC). Clinical Care of Leishmaniasis | Leishmaniasis | CDC (2024).
5. Centers for Disease Control and Prevention (CDC). About Leishmaniasis | Leishmaniasis | CDC (2024).
6. Eastern Mediterranean Health Journal (Yasmin S et al.). Epidemiology and risk factors for cutaneous leishmaniasis in Pakistan (2026).
7. Emerging Infectious Diseases, CDC (Hussain M et al.). Epidemiology of Cutaneous Leishmaniasis Outbreak, Waziristan, Pakistan (2018).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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