Symmetrical cutaneous leishmaniasis.

Sir, Cutaneous leishmaniasis (CL) is a protozoan disease present in Old and New Worlds (1, 2). It is endemic in the Mediterranian basin, particularly in the rural areas of Sicily where almost 60% of Italian cases occur. The disease is caused by parasites of the genus Leishmania infantum, carried by specific species of sandflies as Phlebotomus perniciosus and Phlebotomus perfiliewi perfiliewi (3, 4). The main reservoir of human infection is represented by dogs and rodents, and population groups at greater risk include shepherds, farmers and people living in the country, with no distinction as to sex or age (1). Although the classical presentation of the disease consists of an erythematous papule/nodule appearing on bite-exposed areas, which progresses to an ulcer and spontaneously heals over months to years, many other forms have been reported, depending on the infecting species and the host response (1, 2). We report three cases of CL, characterized by symmetrical foci.