{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T13:03:39Z","timestamp":1768914219160,"version":"3.49.0"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,4,10]],"date-time":"2019-04-10T00:00:00Z","timestamp":1554854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cutaneous leishmaniasis (<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content>) remains a prioritized neglected tropical disease. <jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content> novel presentations call for updating its features.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multiregional cohort of 396 patients with confirmed <jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content> was reviewed. Lesion's clinical stage and eruption type were assigned. Disease was considered as extensive if numerous (\u22655), large (&gt;3 cm), disfiguring, threatening vital sensory organs, and\/or older than 12 months. Microscopically, Ackerman's inflammatory pattern, Ridley's pattern (RP), and parasitic index (PI) were recorded. Microscopic variables pertaining to the organisms, epidermis, and host's inflammatory response were also assessed. All cases were confirmed and speciated molecularly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In our region, 71.8% of cases showed extensive disease with 15.7% exceeding 12 months duration. <jats:italic>Leishmania tropica<\/jats:italic> accounted for 91.3% of cases while <jats:italic>Leishmania major<\/jats:italic> constituted 8.7% and presented solely as dry lesions. The dominant inflammatory composite consisted of plasma cells, lymphocytes, and histiocytes. Granulomatous inflammation was present in 55.5%. Most cases showed interface changes (72.7%), spongiosis (75.3%), and marked epidermal hyperplasia (63.9%). Transepidermal elimination of organisms was present in 29.2% of cases. None of traditional classification patterns (clinical stage, microscopic pattern, and <jats:styled-content style=\"fixed-case\">RP<\/jats:styled-content>) showed the predicted linear correlation with lesion age. High and low <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> levels correlated with early and healing microscopic patterns, respectively, but did not correlate with the corresponding <jats:styled-content style=\"fixed-case\">RP<\/jats:styled-content>s. <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> was bimodal with peaks at 3\u20136 and 9\u201312 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Cutaneous leishmaniasis is an evolving disease defying the traditional prediction classifications. Our study sets the ground for adopting updated clinical courses, microscopic presentation, and species mapping.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijd.14451","type":"journal-article","created":{"date-parts":[[2019,4,10]],"date-time":"2019-04-10T07:16:58Z","timestamp":1554880618000},"page":"834-843","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Cutaneous leishmaniasis: an evolving disease with ancient roots"],"prefix":"10.1111","volume":"58","author":[{"given":"Maelle","family":"Saliba","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine American University of Beirut Medical Center Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Awss","family":"Shalhoub","sequence":"additional","affiliation":[{"name":"Faculty of Medicine American University of Beirut Medical Center Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suad","family":"Taraif","sequence":"additional","affiliation":[{"name":"Department of Pathology Temple University Hospital Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asif","family":"Loya","sequence":"additional","affiliation":[{"name":"Department of Pathology Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad A.","family":"Houreih","sequence":"additional","affiliation":[{"name":"Department of Pathology Tishreen University Lattakia Syrian Arab Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rana","family":"El Hajj","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine American University of Beirut Medical Center Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Khalifeh","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine American University of Beirut Medical Center Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,4,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02762013000100001"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0004349"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13071-017-2028-5"},{"key":"e_1_2_10_5_1","first-page":"601","article-title":"History of medical parasitology and parasitic infections in Iran","volume":"19","author":"Edrissian G","year":"2016","journal-title":"Arch Iran Med"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-7020-5101-2.00048-0"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2010.140288"},{"key":"e_1_2_10_8_1","unstructured":"World Health Organization Report.Working to overcome the global impact of neglected tropical diseases 2010. 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