Introduction
Post kalazar dermal leishmaniasis (PKDL) a known complication of visceral leishmaniasis (VL), can lead to severe disfigurement in affected individuals. It is characterized by the development of papules, nodules and macules following the successful treatment of VL. It is most common with VL caused by L donovani and is rare in VL caused by L infantum and L chagasi. In Sudan it occurs with a frequency of 58% of patients treated for VL. In the majority of Sudanese patients it occurs within the first two months following treatment of VL. Spontaneous healing occurs in the majority of cases
Clinical features
PKDL often mirrors the clothing habits of the patient, being confined to (or most severe in the sun-exposed parts of the skin.
Lesions of PKDL are papules, nodules, macules and a combination of these occurring in the exposed parts of the body. This patient shows a papulonodular form of PKDL
The above –mentioned observations lead to the hypothesis that the lesions of PKSDL are related to exposure to sunlight. It is unlikely that this is due to the infrared part of sunlight since infrared light is used in the treatment of cutaneous leishmaniasis. It is known that the elimination of the intracellular leishmania parasites is dependent on activation of macrophages by IFN-γ (secreted by Type 1 T cells). UV light depresses Type 1T cell responses and this may be the link between UV light and PKDL
What is the evidence
Mechanism of immunosuppression
Post kalazar dermal leishmaniasis (PKDL) a known complication of visceral leishmaniasis (VL), can lead to severe disfigurement in affected individuals. It is characterized by the development of papules, nodules and macules following the successful treatment of VL. It is most common with VL caused by L donovani and is rare in VL caused by L infantum and L chagasi. In Sudan it occurs with a frequency of 58% of patients treated for VL. In the majority of Sudanese patients it occurs within the first two months following treatment of VL. Spontaneous healing occurs in the majority of cases
Clinical features
PKDL often mirrors the clothing habits of the patient, being confined to (or most severe in the sun-exposed parts of the skin.
Lesions of PKDL are papules, nodules, macules and a combination of these occurring in the exposed parts of the body. This patient shows a papulonodular form of PKDL
The above –mentioned observations lead to the hypothesis that the lesions of PKSDL are related to exposure to sunlight. It is unlikely that this is due to the infrared part of sunlight since infrared light is used in the treatment of cutaneous leishmaniasis. It is known that the elimination of the intracellular leishmania parasites is dependent on activation of macrophages by IFN-γ (secreted by Type 1 T cells). UV light depresses Type 1T cell responses and this may be the link between UV light and PKDL
What is the evidence
Mechanism of immunosuppression
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