Preventive Measures for Pkdl and Major Challenges Publisher



Asgari S ; Valizadeh M ; Ataei B ; Karami H ; Azaraeen S ; Kamali A ; Abhishek K ; Gholami M ; Nejad ASM
Source: Leishmaniasis: Pathogenesis and Potential Treatment Published:2026

Abstract

Post-kala-azar dermal leishmaniasis (PKDL) is a significant yet often overlooked complication following the treatment of visceral leishmaniasis (VL) (kala-azar). This debilitating skin condition manifests as macular, papular, or nodular lesions, appearing months to years after successful treatment of the initial infection. Although not immediately life-threatening, PKDL imposes considerable social and psychological burdens on affected individuals, leading to stigmatization and diminished quality of life. The condition is endemic in several regions, including India, Bangladesh, Nepal, and parts of Africa and the Middle East, with prevalence rates among treated kala-azar patients ranging from 2.5% to 20%. However, the true incidence of PKDL is likely underestimated due to underreporting and misdiagnosis, especially in resource-limited settings. The pathogenesis of PKDL is multifactorial, involving interactions between the host's immune response, the Leishmania parasite, and environmental factors. Persistent low-level parasitemia and genetic predisposition are believed to contribute to the disease's emergence. Addressing PKDL is crucial not only for improving patient outcomes but also for eliminating VL, as PKDL patients can act as reservoirs for Leishmania, perpetuating transmission. Current research emphasizes the need for effective preventive measures, reliable diagnostic tools, and optimized treatment regimens. The World Health Organization (WHO) has made significant strides in understanding PKDL's epidemiology and risk factors, yet challenges remain in implementing comprehensive surveillance and monitoring systems. This review highlights the latest advancements in PKDL research, focusing on preventive strategies and the critical barriers to effective management. Additionally, the psychological and psychosocial impacts of PKDL are profound, necessitating integrated care approaches that involve psychologists and psychiatrists. These professionals play essential roles in addressing the mental health needs of PKDL patients, combating stigma, and enhancing overall well-being. A multidisciplinary approach is essential for effectively managing PKDL, involving vector control, early diagnosis, and health education. In conclusion, mitigating the burden of PKDL requires collaborative efforts among researchers, public health authorities, and affected communities. Strengthening healthcare infrastructure, improving access to diagnostics and treatments, and raising awareness are crucial steps toward alleviating the impact of this neglected tropical disease. Ongoing research into the pathogenic mechanisms of PKDL and the development of novel interventions is vital for effective prevention and management, ultimately contributing to the elimination of VL in endemic regions. © 2026 selection and editorial matter, Veer Singh, Ashish Kumar, Kumar Abhishek; individual chapters, the contributors.