Cutaneous leishmaniasis (CL) in India is predominantly caused by Leishmania tropica. The classic Old World CL lesion is called 'Oriental sore'. Which clinical feature is the HALLMARK of this presentation?

• A Moist, exudative plaque with satellite papules
• B Vesicular eruption resembling herpes zoster
• C Annular scaly plaque with central clearing
• D Painless, indurated nodule or plaque that ulcerates with a raised, rolled border ('volcano crater' ulcer) ✓

Explanation

Oriental sore (Old World CL) presents as a painless papule that slowly enlarges into an indurated nodule or plaque, then ulcerates with a characteristic raised, rolled, indurated border giving the 'volcano crater' or 'pizza' appearance. The ulcer base is granular and may have overlying crust. Lesions are typically on exposed sites (face, arms). Diagnosis is confirmed by slit-skin smear, tissue biopsy (Leishman-Donovan bodies), culture or PCR. Treatment uses pentavalent antimonials or miltefosine.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

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