This woman had leishmaniasis, a vector-borne disease transmitted by the sand fly. The disease can be divided into 2 major forms: a cutaneous form, which is the most common, and the visceral form. There is also a more rare mucocutaneous form that can cause significant facial disfigurement around the nose and mouth.
Leishmaniasis is transmitted to people through the bite of the sand fly. Rural areas have a higher prevalence of disease in endemic countries. Six weeks after a sand fly bite, the cutaneous form may be localized to a single ulcer or nodule--or disseminated widely. The cutaneous form of leishmaniasis has a predilection for the nose and face, as seen in this case. Cutaneous leishmaniasis is also commonly seen on the extremities. Note that the sand fly would generally have more access to the face and extremities, where clothing is less likely to act as a protective barrier.
Cutaneous leishmaniasis may be diagnosed by clinical appearance and a biopsy or a scraping of the ulcer. A Giemsa stain will demonstrate parasites in the skin smears taken from the edge of an active ulcer. The main drugs used to treat leishmaniasis include sodium stibogluconate (available from the Centers for Disease Control and Prevention) and meglumine antimoniate.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Berggren R, Usatine R. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:53-79.
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