Cutaneous Leishmaniasis Mimicking Pyoderma Gangrenosum.

Cutaneous leishmaniasis (CL) is caused by leishmania, a single-called parasite and is transmitted the bite of sand fly. It characterized by ulcers, which are usually without pain or pruritus. Both old world and new world species cause localized CL. Old world disease begins as a small erythematous papule at the site of the bite of the sand fly and over several weeks it enlarges up to 3 cm eventually becoming eroded and crusted. After lasting for several months the ulcer heals with a slightly depressed scar. We report the case of a 27-year-old man native of South India, carpenter by occupation, working in Saudi Arabia for >5 years who presented with a painful ulcer of 10 cm in diameter over his right shoulder with purulent discharge. He was diagnosed to have CL and was treated with intramuscular injection of sodium stibogluconate 20 mg/kg/day for 30 days. The resultant cribriform scar resembled that of pyoderma gangrenosum.

The conundrum of parapsoriasis versus patch stage of mycosis fungoides.

Terminological confusion with benign dermatosis, such as parapsoriasis en plaques, makes it difficult to diagnose mycosis fungoides in the early patch stage. Early diagnosis of mycosis fungoides (MF) is important for deciding on type of therapy, prognosis and for further follow-up. However, until recently, there has been no consensus on criteria that would help in diagnosing the disease early. Some believe that large plaque parapsoriasis (LPP) should be classified with early patch stage of MF and should be treated aggressively. However, there is no firm clinical or laboratory criteria to predict which LPP will progress to MF and we can only discuss about statistical probability. Moreover, long-term outcome analysis of even patch stage of MF is similar to that of control population. We therefore believe that LPP should be considered as a separate entity at least to prevent the patient from being given a frightening diagnosis. We also feel that patients need not be treated with aggressive therapy for LPP and will need only a close follow-up. This article emphasizes the criteria for diagnosing early MF and has highlighted the importance of considering LPP as a distinct benign entity.