Table 1.

Main differences between Indian and African Post kala-azar dermal leishmaniasis

Location	Indian PKDL[1,2,4,11]	African PKDL[12,13,14]
Epidermis	Normal to atrophic or stretched	Hyperkeratosis, parakeratosis, and follicular plugging
	Follicular plugging	Liquefaction degeneration of basal cells with focal infiltration by lymphocytes
Dermis	Lymphocytes and plasma cells predominate with scattered macrophages	Lymphocytes predominate histiocytes are seen but plasma cells are scant or absent
	Generally sparse LDB; numerous may be seen in papules and nodules but almost never in macules	LDB seen in 20% of cases, more so in those extensive involvement (grade 3)
	Epithelioid cell granuloma with or without giant cells rare	In about half the cases scattered epithelioid cells or compact granulomas with giant cells can be seen
	Blood vessels in papulo-nodules show thickened hyalinized walls and endothelial swelling	Neuritis seen with Schwann cell hyperplasia and LDB within nerves
		Blood vessel changes not mentioned
Leishman-Donovan bodies or amastigotes	Maximally found in superficial dermis	Maximally seen just below epidermis
Clinico-pathologic correlation	Changes in blood vessels and collagen were seen in nodules of long duration	No such correlation reported between duration of lesion and histopathology
Electron microscopic findings	Lymphocytes found in intimate contact with melanocytes and basal keratinocytes; dermis infiltrated by a mixture of lymphocytes and macrophages	Rich cellular infiltrate of plasma cells and lymphocytes around parasitized macrophages
Immunopathology	Lymphocytes in early lesions are CD4+ and CD8+, but as PKDL becomes chronic and nodular CD8+cells predominate	Most of the cells are CD3+ with a preponderance of CD4+ over CD8+ cells