Iqbal Akhtar Khan, Muhammad Ahmad Khan.
Managing Cutaneous Leishmaniasis: From Peru to Pakistan.
J Pak Assoc Derma Jan ;10(2):5-15.

The first ever case of cutaneous leishmaniasis (CL) was recorded in Peru 1580 by Balhaser Ramirez. The disease known to originate in Pampas (Peru) in the local markets of which the pottery jugs of that time showed distinctive lesions similar to those seen in CL in the modern age has now become endemic in over 70 countries. The so called` non endemic zones` are no longer `protected zones`. Due to rapidly growing international tourism industry and enormously expanding number of exchange workers, the toll of imported cases is going high up. Moreover with the impact of global warming, CL may not remain domain of tropical countries. Where as the yearly incidence of CL is estimated at 1 .5 million cases, 90% of those occur in Afghanistan, Brazil, Iran, Peru, Saudi Arabia and Syrian Arab Republic. In the last decade the reporting of CL from various parts of Pakistan has alarmingly increased which cannot simply be attributed to improved case detection. The long continued struggle to find out a safe, affordable, and effective treatment for CL has not been well rewarding: and antimonial (systemic or intralesional) still remain, in most if not all spots on globe, as mainstay in therapy. However, the weapons against CL are being improved. Amongst the various methods of heat therapy the `Baghdadin device` is drawing attention as a promising tool. Topical paromomycin, in improved formulation, has demonstrated high cure rate. Oral ketoconazole and intralesional zinc sulphate have brought very good results. Hypertonic sodium chloride solution intralesionally has exhibited efficacy comparable with antimonials. Significant steps in the battle against CL include its elimination form urban areas of Azerbaijan, Israel, Kazakhstan and Turkmenistan: and encouraging results with the trials of vaccine in Ecuador and Iran.

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