Lupoid leishmaniasis due to Leishmania major with remaining large scars: report of 2 cases.

Lupoid leishmaniasis, a clinical form of cutaneous leishmaniasis, was described by Christopherson in 1923 [1]. It is a chronic condition that typically follows acute cutaneous leishmaniasis infection. In this clinical form, 1 to 2 years after healing of the acute lesion, new papules and nodules appear at the margin of the remaining scar. The papules have a granulomatous, lupoid appearance and are often associated with scaling. They characteristically present at the margin of the scarred area. Less commonly lesions may present months or years after the acute lesion has healed [2]. Most reported cases are associated with old world strains of leishmaniasis and Leishmania tropica is responsible for the majority of such cases [3]. The incidence of lupoid leishmaniasis has been reported in previous studies to range from 0.5% to 6.2% [4,5]. Histological features of this condition include well-organized epithelioid granulomas, surrounded by lymphocytes, amastigotes are absent and culture for leishmaniasis is frequently negative [4]; however, the leishmanin test is usually positive [5]. Lupoid cutaneous leishmaniasis is prevalent in endemic area of leishmaniasis, particularly in the Middle East and Afghanistan [6]. In this report we describe 2 cases of lupoid leishmaniasis that were not diagnosed for several years and caused large scars on the face.