Cutaneous leishmaniasis

Cutaneous leishmaniasis, commonly known in Afghanistan as “sal-dana,” is one of the important skin conditions seen in Kabul and several other parts of the country. It often starts as a small bump on the skin, but over time it may grow, become an open sore, and leave a visible scar if it is not assessed and managed properly.

This condition is caused by a tiny parasite that is transmitted through the bite of infected sand flies. Sand flies are very small insects that may live in dusty areas, old houses, cracks in walls, poorly cleaned surroundings, and places where waste or moisture is present.

How does cutaneous leishmaniasis develop?

When an infected sand fly bites a person, the parasite can enter the skin. After a few weeks or sometimes months, a small bump, nodule, or sore may appear at the site of the bite. At first, the sore may not be painful, which is why many people mistake it for a simple insect bite, acne-like bump, or ordinary wound.

The important difference is that a leishmaniasis sore usually heals slowly and may change in size and appearance over time.

Common signs of cutaneous leishmaniasis:
– A small red or raised bump on the skin
– A sore that slowly becomes larger
– Raised edges with a central crater-like area

– Dry crust or scab over the wound

– Little pain or no pain in many cases
– A scar or mark after healing
– Swelling of nearby glands in some patients

Where do the sores usually appear?

Because sand flies usually bite exposed areas of the body, sores are commonly seen on the face, hands, arms, legs, and neck. In children, sores on the face can be especially stressful for families because they may leave noticeable scars.

Is cutaneous leishmaniasis dangerous?

Cutaneous leishmaniasis is not usually life-threatening, but it can affect appearance, confidence, and quality of life. A sore on the face, nose, lips, or around the eyes should be evaluated carefully. Medical attention is also important if there are multiple sores, signs of infection, pus, increasing pain, slow healing, or if the patient has a weak immune system.

Can leishmaniasis heal on its own?

Some sores may improve with time, but this does not mean they should be ignored. In many cases, the wound may remain open for a long period or leave a permanent scar. It is also important to remember that other skin diseases can look similar to leishmaniasis, so proper diagnosis by a dermatologist is very important.

How is it diagnosed?

A dermatologist usually evaluates the appearance of the sore, asks about the patient’s history, and may request laboratory tests when needed. Self-diagnosis or using unknown creams, strong home remedies, or unverified medicines can worsen the wound and increase the chance of scarring.

Treatment options:

Treatment depends on the number of sores, their size, location, duration, the patient’s age, and overall health. Some cases may require specific medicines, while others may be managed with local procedures or wound care under medical supervision. The best treatment plan should always be selected after a proper dermatology consultation.

Patients should not burn, cut, scratch, puncture, or apply harsh substances such as acids, salt, garlic, unknown creams, or strong chemicals to the sore. These practices can damage the skin and may lead to deeper scars.

How to reduce the risk:

Prevention is especially important in places where dust, old buildings, and poor environmental hygiene can increase sand fly exposure.

Helpful prevention steps include:

– Protecting yourself from insect bites, especially in the evening and at night
– Using window and door screens
– Sleeping under a bed net when needed
– Repairing wall cracks and holes at home
– Keeping waste and dust away from living areas
– Wearing long-sleeved clothing in areas with insects
– Asking a healthcare professional about safe insect repellents

What about scars after leishmaniasis?

After the sore heals, some people may have a scar, depression, or dark mark on the skin. Modern dermatology offers several options that may improve the appearance of scars, such as laser treatments, microneedling, skin resurfacing procedures, and personalized scar care. However, the right option depends on the type of scar and should be chosen after examination by a qualified dermatologist.

When should you see a dermatologist?

Any sore that lasts more than two to three weeks, grows larger, forms a crust, becomes painful, produces pus, or looks unusual should be taken seriously. This is especially important for people living in Kabul or other areas where leishmaniasis is common.

At Arvin Skin Hospital, patients can visit for evaluation of suspicious skin sores, diagnosis of skin conditions, and specialist dermatology advice. For any skin problem or decision about cosmetic procedures, it is always recommended to consult a qualified dermatologist and trusted medical centers such as Arvin Dermatology and Cosmetic Hospital or Kara Skin Hospital.

Conclusion:

Cutaneous leishmaniasis, or sal-dana, is a significant skin condition in Afghanistan. With awareness, prevention, and timely dermatology care, many complications and long-term scars can be reduced. A slow-healing skin sore should never be ignored. Early diagnosis and scientific care can help protect both skin health and appearance.

Sources:
1. World Health Organization (WHO) – Leishmaniasis Fact Sheet:
https://www.who.int/news-room/fact-sheets/detail/leishmaniasis

2. WHO Eastern Mediterranean – Leishmaniasis in Afghanistan:
https://www.emro.who.int/afg/programmes/leishmaniasis.html

3. Centers for Disease Control and Prevention (CDC) – Leishmaniasis:
https://www.cdc.gov/dpdx/leishmaniasis/index.html

4. CDC – Signs and Symptoms of Leishmaniasis:
https://www.cdc.gov/leishmaniasis/signs-symptoms/index.html