Dermoscopy of Post Kala-Azar Dermal Leishmaniasis.

Post Kala-azar dermal leishmaniasis (PKDL) is a late cutaneous manifestation of untreated or partially treated visceral leishmaniasis (VL) and is caused by the same organism, i.e., Leishmania donovani. It characteristically manifests as macules, nodules, plaques, and facial erythema. A 19-year-old male presented with erythematous fleshy papules confined to the chin [Figure 1], along with hypopigmented macules involving the trunk and lower limbs. On evaluation, the patient revealed a history of Kala-azar 1.5 years back with RK-39 test positivity for the patient. Dermoscopy of the erythematous papule from the chin was performed using Dermlite II hybrid m dermatoscope at 10 × magnification in polarized mode and photographs were captured, which revealed multiple yellow tears and erythema [Figure 2]. Histopathology confirmed the diagnosis of PKDL [Figure 3].

Figure 1

Erythematous fleshy papules confined to the chin along with hypopigmented macules involving the trunk

Figure 2

Dermoscopy of the erythematous papule from the chin revealed erythema, multiple yellow tears with few yellow clods (Polarized, 10×)

Figure 3

Dense infiltrates of plasma cells, histiocytes, and epithelioid cells with occasional round to oval basophilic bodies. (H and E, 10×)

PKDL is a late cutaneous manifestation of VL in untreated or inadequately treated patients. From India, three main presentations have been described, of which one may predominate – erythema and induration on the butterfly area of the face that shows photosensitivity; multiple symmetrical hypopigmented macules that may coalesce; and combinations of papules, nodules, and plaques.[12] Usually, PKDL lesions typically appear around the mouth and spread to other parts of the face; subsequently, spread to upper arms and chest may follow. This pattern is most consistent in papular and nodular PKDL, but to a lesser extent in macular lesions.[3] Skin biopsy from the lesions on the chin (papules) showed dense infiltrate of lymphocytes and epithelioid cells with occasional round to oval bodies in macrophages. Several dermoscopic findings have been described in cutaneous leishmaniasis,[4] the most common ones include erythema, various configurations of vascular structures, white starburst-like patterns, central ulcers, yellow tears, and hyperkeratosis.[567] Because erythema, hyperkeratosis, and hairpin vessels may be observed in many dermatological conditions, they are not considered to be specific for diagnosing cutaneous leishmaniasis.[4] In our patient, yellow tears along with erythema were the main features. Yellow tears correspond to the follicular plugs due to compression stemming from lesional growth and expansion. Thus, dermoscopy can be an auxiliary tool for the diagnosis of PKDL.

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Conflicts of interest

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