Leishmaniasis currently threatens 350 million people in 88 countries around the world. Ninety per cent of cutaneous leishmaniasis (CL) cases occur in Afghanistan, Brazil, Iran, Peru, Saudi Arabia, and Syria. An epidemic of cutaneous leishmaniasis is ongoing in Kabul, Afghanistan with an estimated 200 000 cases. Lesions can be very disfiguring, particularly on the face, which may have long term psychological and social consequences. Over the past 10 years endemic regions have been spreading further afield and there has been a large increase in the number of recorded cases.

Over the past five years, at the Hospital of Tropical Diseases in London, we have been involved in the diagnosis and treatment of six children with CL due to L tropica and three …