Comparison between cutaneous leishmaniasis patients with facial and non-facial lesions

Background: We compared demographic, clinical, treatment, and outcome characteristics of facial cutaneous leishmaniasis (CL) and non-facial CL. Methods: In this retrospective cohort study, polymerase chain reaction confirmed Leishmania major CL patients with ≥2 documented hospital visits, 2014–2019, were included. Results: Overall, 134 patients (34% and 66% with facial and non-facial CL, respectively) were included. Facial CL patients were younger (43% vs. 8% <18 years, P < 0.001), with a higher proportion of females (41% vs. 25%, P = 0.07) compared with non-facial CL. Clinical characteristics, including number and size of lesions and ulcer appearance, were similar in both the groups. Higher paromomycin/methylbenzethonium chloride ointment treatment rates were noted in facial CL (85% vs. 64%, P = 0.02). Intralesional sodium stibogluconate was given to 41% and 53% of facial CL and non-facial CL patients, respectively (P = 0.21). Cryotherapy and surgery were only used in non-facial CL patients (5% and 1% of all CL cases, respectively). Systemic treatment (oral miltefosine, intravenous [IV] sodium stibogluconate, IV liposomal amphotericin B) was used in <5% of the cases in both the groups. Overall, 84% of patients showed signs of improvement, including decreased lesion size or clinical improvement in 73% and 75% of patients, respectively. Only 5% of all cases healed without scarring. Outcome rates were similar in both groups. Conclusions: Facial CL patients were younger and received more frequently Leishmania-specific topical treatment than non-facial CL patients. In contrast, the two groups were similar regarding clinical characteristics and outcome. These findings suggest differences in disease severity perception by patients and physicians.