Features:
(1) The patient has a history of recent, past or current therapy of visceral leishmaniasis (kala-azar). In India it tends to occur 2-7 years after treatment while in the Sudan it usually within 6 months.
(2) The condition is only associated with L. donovani sensu stricto cluster.
(3) The rash may be macular, maculopapular, nodular, plaque-like or depigmented macules.
(4) The rash starts about the mouth (perioral) then spreads to the cheeks and forehead and scalp. They may preferentially involve old areas of scarring (Kobner's phenomenon).
(5) Most patients are asymptomatic. Usually the lesions regress spontaneously. Systemic illness may be seen in small children 0-4 years old with Grade 3 disease.
(6) Amastigotes may be found in skin lesions but often the diagnosis is made clinically without biopsy (especially if lesions are limited to the face). Usually the number of parasites is very low. Parasites are more likely to be found in larger papules or nodules. Amastigotes may also be seen in lymph node or bone marrow biopsy. PCR is more sensitive and can be done on aspirates.
(7) Patients with visceral leishmaniasis who show high interleukin-10 plasma levels are more likely to develop PKDL.
Grading is based on distribution and density of the lesions.
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Lesions
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Grade
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mainly on face and head with some lesions on upper arms, chest and back; hands and feet are free
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1
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lesions involve the head, scalp, forearms, upper legs, upper chest and back; lesions gradually decrease as proceed distally in the limbs; hands and feet are free
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2
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generalized over the entire body, including the hands and feet
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3
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Therapy may be warranted if the disease is severe or prolonged and consists of one of the following:
(1) sodium stiboglutonate 20 mg/kg per day for 2 months
(2) liposomal amphotericin B
