Kudos to the cutaneous leishmaniasis case [Derm Clinics, “A painless nonitchy rash”]. This is a disease that will affect clinicians in the southwest US and eventually the entire country as climate warming progresses. Currently, very few providers can make the correct diagnosis, and counter to the authors’ recommendation to refer the patient to a leishmaniasis expert, these experts are extremely numbered. There are treatments, but the process is complicated. The most effective treatment differs depending on the strain of leishmania contracted.

One treatment option is amphotericin B, used originally to treat systemic fungal infections. It is also effective against mucosal leishmaniasis, but the treatment is not pleasant. It is often called “amphoterrible.” Kidney functions must be closely monitored and treatment stopped if kidney function drops below 40%.

The authors chose not to discuss mucosal leishmaniasis in detail, which involves the parasites migrating to the mucosal tissues of the mouth and nose. Although they are often referred to as flesh-eating, the parasites do not consume tissue. Rather, the body has a profound immune response, eventually deforming and destroying the nose and mouth. There is no “cure.” This is a chronic infection, and we have yet to find a vaccination that works any better than the body’s own natural responses.—Richard E. Harbin, MSN, MEd, CPNP, ARNP, Redondo Beach, Calif.

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