Figure I.

The clinical context of post-kala-azar dermal leishmaniasis (PKDL) development. Visceral leishmaniasis (VL) is marked by high visceral parasite loads and is often associated with a weak or negative result for the leishmanin skin test (LST). The absence of LST reactivity is indicative of low cellular immunity against leishmanial antigens. VL is often successfully treated with antimonials resulting in a reduction of parasite load and recuperation of antileishmanial response. This stage of disease resolution is often where PKDL is initiated. PKDL develops in three clinically relevant stages, spreading as a hypopigmented rash from the periorificial regions of the face to the periphery as a maculopapular or ulcerative rash.