In this population of CL patients displaying variable degrees of complexity and severity, almost two-thirds of patients could be initially managed without systemic therapy. Of these, 60 were cured before day 60. The WHO-recommended stepwise approach favoring initial local therapy therefore resulted in at least 44% of all patients being cured without exposure to the risk of systemic adverse events. Efforts are needed to further simplify local therapy of CL and to improve the management of patients with complex lesions and/or preexisting comorbidities.

Tibial lymphoplasmacytic plaque (TLP) is a recently recognized clinicopathological entity affecting children and is characterized by a linear, reddish brown plaque on the leg with a dense dermal lymphoplasmacytic infiltrate. No effective treatments are available for this lesion of unknown etiology and its course is chronic. We report a new case in which, for the first time, a causative factor (insect bite) is strongly suspected. The clinical and pathological features of TLP may be misleading for the uninformed dermatologist or pathologist. Therefore, we would like to draw attention to this very distinctive clinicopathological presentation in order to help them recognize it easily and prevent it from being misdiagnosed as an infectious disease or, above all, a cutaneous lymphoma. We will discuss the relationship between TLP and linear acral pseudolymphomatous angiokeratoma of children, a variant of pseudolymphoma localized on acral sites in children which may share some of TLP’s histopathological features.

No abstract

A patient with an ulcerated cutaneous leishmaniasis of the pinna had suppurative otochondritis after a first unsuccessful course of treatment with meglumine antimoniate. Although the Leishmania ulceration healed after a second course of meglumine antimoniate, and despite three oral dicloxacillin or pristinamycin courses, the otochondritis extended and an abscess developed. Pus from the abscess revealed a pure culture of Pseudomonas aeruginosa. Five days of oral ciprofloxacin plus rifampin led to a marked improvement. The P. aeruginosa isolate was sensitive to ciprofloxacin but fully resistant to rifampin. Healing with minimal mutilation was obtained at the end of a six-week course of multiple antibiotic therapy. Pseudomonas aeruginosa otochondritis was a co-factor of cartilage mutilation in this patient. Thus, infection with P. aeruginosa should be promptly treated when present in tender cutaneous or mucosal leishmaniasis lesions near cartilaginous areas.