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The severity of the disease is dependent on parasite species as well as the immune responses evoked by the host. Most cases of<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content>heal spontaneously. In rare cases, the ulcer\/s become chronic, and some<jats:italic><jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>eishmania<\/jats:italic>species may induce mucosal leishmaniasis (<jats:styled-content style=\"fixed-case\">MCL<\/jats:styled-content>) leading to severe tissue damage. Due to difficulties in obtaining skin tissue, most human studies of<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content>have been limited to the analysis of peripheral blood. While systemic responses may be good correlates of immunity, tissue damage and local immune responses at the site of infection is seldom reflected in alterations in the peripheral blood. In this review, we discuss the different forms of<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content>focusing on the<jats:italic>in situ<\/jats:italic>responses in established disease and the mechanisms involved in pathology and healing of<jats:italic><jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>eishmania<\/jats:italic>infection. Great effort has been put into animal models dissecting the immune events behind the evolution of disease, tissue pathology and parasite control. These models of genetically engineered, immune deficient mice or mice given therapy prior to onset of overt disease poorly reflect the clinical situation, where patients seek treatment once infection is well established. Models of established disease are needed to address the clinical challenge of identifying new therapeutic targets in treatment<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content>. Through understanding immune deviations during<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content>potential benefits and risks of emerging biological drugs in leishmaniasis can be addressed.<\/jats:p>","DOI":"10.1111\/pim.12007","type":"journal-article","created":{"date-parts":[[2012,9,26]],"date-time":"2012-09-26T13:01:55Z","timestamp":1348664515000},"page":"551-561","source":"Crossref","is-referenced-by-count":92,"title":["Tissue damage and immunity in cutaneous leishmaniasis"],"prefix":"10.1111","volume":"34","author":[{"given":"S.","family":"Nyl\u00e9n","sequence":"first","affiliation":[{"name":"Department of Microbiology Tumor and Cell Biology Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Eidsmo","sequence":"additional","affiliation":[{"name":"Molecular Dermatology Department of Medicine Solna Karolinska Institutet Stockholm 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