Though any organism causing kala-azar can lead to PKDL, it is commonly associated with Leishmania donovani which gives different disease patterns in India and Sudan.

[citation needed] Current approach to diagnosis involves Newer polymerase chain reaction (PCR) based tools have higher sensitivity and specificity.

For example, in one study, despite treatment with high doses of sodium stibogluconate for 28 days, only 30% of patients remained disease-free at 12 months follow-up.

[12] Several drug combinations with immunomodulators have been tested, for example, a combination of pentoxifylline (inhibitor of TNF-α) and a pentavalent antimonial at a high dose for 30 days in a small-scale (23 patients) randomised placebo-controlled study from Brazil achieved cure rates of 90% and reduced time to cure,[13] a result that should be interpreted cautiously in light of inherent limitations of small-scale studies.

[14] In an earlier small-scale (12 patients) study, addition of imiquimod showed promising results[15] which need yet to be confirmed in larger trials.

[citation needed] Diagnosis is based on the characteristic appearance of non-healing raised, scaling lesions that may ulcerate and become secondarily infected with organisms such as Staphylococcus aureus, in someone who has returned from an endemic area.

[citation needed] In resource limited settings, fine-needle aspiration of the lesion is confirmatory with identification of amastigote form of Leishmania.

Pentavalent antimonial drugs (sodium stibogluconate (SSG) and meglumine antimonate (Glucantime, MA)) have been used since the 1940s, but they are expensive, toxic, and painful.

Unfortunately, leishmaniasis is an orphan disease in developed nations, and almost all the current treatment options are toxic with significant side effects.

[18] Similar to ACML, the treatment recommendations for Old World cutaneous leishmaniasis (OWCL) are uncertain due to the variability of and inconsistencies within the research.

In the New World, these organisms include L. amazonensis, L. braziliensis, L. guyanensis, L. lainsoni, L. lindenbergi,[21] L. mexicana, L. naiffi, L. panamensis, L. peruviana, L. shawi, and L. venezuelensis.

[25] The sand fly stings mainly at night, and it usually occurs about half a meter above the ground (so sleeping on high beds can prevent infection).

[citation needed] Studies conducted in recent years show that the plant Bougainvillea glabra may protect against the sand fly.

[28] The Middle East, in 2016, seems to be experiencing an increase in the cutaneous leishmaniasis disease due to migrants fleeing the Islamic State of Iraq and the Levant.

[32] A recent study with large series of cases from Mid-western region of Nepal have demonstrated that cutaneous leishmaniasis is an under recognized medical condition posing health challenges mandating new guidelines for its elimination/ eradication.