What are the key clinical features that differentiate cutaneous leishmaniasis from other skin lesions?

Key clinical features that differentiate cutaneous leishmaniasis from other skin lesions include:

• Typical lesion appearance: Cutaneous leishmaniasis usually presents as a painless, slowly enlarging papule or nodule that often ulcerates, forming a characteristic well-demarcated, raised border with a central crater or ulceration. This contrasts with many other skin lesions that may be painful, rapidly evolving, or lack this distinctive ulcerative morphology ¹ (Von Stebut, 2015).
• Chronicity and progression: The lesion tends to persist for weeks to months without spontaneous resolution, unlike common bacterial or fungal infections which often respond to treatment or resolve more quickly ¹ (Von Stebut, 2015).
• Location and number: Lesions commonly occur on exposed areas such as the face, arms, and legs, often singular but sometimes multiple, which helps differentiate from other dermatoses that may have different distribution patterns ¹ (Mohammadpour et al., 2017).
• Regional epidemiology and travel history: A history of travel to or residence in endemic areas (e.g., parts of the Middle East, South America, and Mediterranean) is a key differentiator, as cutaneous leishmaniasis is a parasitic infection transmitted by sandfly bites, unlike many other skin lesions ¹ (Von Stebut, 2015).
• Associated symptoms: Systemic symptoms are usually absent or mild, which helps distinguish it from systemic infections or inflammatory conditions presenting with skin lesions ¹ (Von Stebut, 2015).
• Laboratory and diagnostic features: Definitive diagnosis requires parasitological confirmation (e.g., microscopy, culture, or molecular methods) from lesion samples, which is not typical for other common skin lesions ¹ (Mohammadpour et al., 2017).

In summary, the combination of a chronic, painless ulcerative skin lesion with raised borders on exposed areas, a relevant travel or exposure history, and parasitological confirmation differentiates cutaneous leishmaniasis from other skin lesions ¹ (Von Stebut, 2015; Mohammadpour et al., 2017).