Lupoid leishmaniasis among the known cases of cutaneous leishmaniasis in Herat Province, western Afghanistan.

Lupoid cutaneous leishmaniasis (LCL) is an uncommon form of chronic cutaneous leishmaniasis, which is mostly caused by Leishmania tropica in the Old World and has a high incidence throughout early life. Between 2012 and 2013, patients with active lesions suspected to be cutaneous leishmaniasis (CL) were examined. Diagnosis was performed through a combination of methods, i.e., clinical examination, direct smears and kDNA polymerase chain reaction (PCR). Overall, 162(4.2%) subjects, through clinical examination and PCR confirmation alone, were diagnosed as having LCL, with the duration of the lesions varying from 2 to 5 years. Most (85.8%) of the subjects with LCL were <20 years of age. No amastigote was found in direct smears. Moreover, direct PCR on the negative smears for identifying Leishmania provided a specificity of 100%, and the species was identified as Leishmania tropica using specific kDNA PCR. Performing PCR on skin smears appears to offer a valuable method for the diagnosis of LCL because it is highly specific and sensitive, especially for clinical correlative studies.