In response.

Dear Sir:

We read with interest Mello and Madeira's comments on our article1 and herein we discuss the points they raised. They emphasized skin scraping for the diagnosis of cutaneous leishmaniasis. We agree that skin scraping is a good method for the diagnosis of cutaneous leishmaniasis; however, it has shown to be less sensitive than press imprint smear (PIS),2–5 and skin scraping should not be done in clearly infected ulcers and should not be performed in non-ulcerated lesions. On the other hand, local anesthesia is recommended for the comfort of the patient. As skin scraping does not elucidate a large proportion of cases of cutaneous leishmaniasis, neither does it allow the diagnosis of several other diseases, so we recommend that a skin biopsy should be performed at the same time. To do it, one will need all things used in PIS, plus a scalpel blade or a curette, making its cost a little higher than with PIS. Suturing is not necessary for a 3-mm punch biopsy. We understand that a microscopy technician with a short training course can learn to identify amastigotes, because he or she is someone already used to see other microorganisms. We are not referring to a lay person on microscopy. On the other hand, the performance of procedures (skin scraping or other) by technicians, is a matter that concerns us because before doing scraping or other procedures, it is necessary to evaluate the patient and the lesion: if the lesion is infected, if it is close to varicose veins, and other aspects of it. These interventions require training and qualification that a technician does not have to perform the tasks Mello and Moreira suggest. We should make all efforts to guarantee that even in poor-resource areas, any intervention in humans, even the simplest one should be done in accordance with the best practices, by qualified professional and under good supervision.