My wife has a parasitic disease called leishmaniasis. This has made open sores on her leg that are very painful. She has been to several dermatologists who don't know how to treat her or who are unwilling to do so. We have yet to find one of them to do a biopsy on it. She has turned to a homeopath for treatment with herbs. Is there any other way of treating this? We have spent a lot of dollars on over-the-counter infection creams for temporary relief. We need a permanent solution. Can you help us?

E.W.

Leishmaniasis is a complex infection caused by a group of protozoa called Leishmania. The disease is spread by the sandfly. There are two major forms, cutaneous (involving the skin) and visceral (involving the internal organs). The visceral form, which can be fatal, is not caused by the same species of Leishmania as the cutaneous form. Therefore, your wife is at little risk of developing serious internal disease.

The cutaneous form of leishmaniasis occurs in many parts of the world, though not in North America or most of Western Europe. In different locations, the infection is known by different names, the most common being "Oriental sore" and "Baghdad boil." So-called "New World cutaneous leishmaniasis" occurs throughout much of Latin America.

Treating leishmaniasis can be difficult, because all of the various treatments are somewhat toxic. The first choice usually involves compounds containing antimony. These are usually effective, but they can have important adverse effects, including heart damage and inflammation of the pancreas. Other choices are amphotericin B (trade name Amphotec) and pentamidine (Pentam), both of which can also be toxic.

As far as your wife is concerned, is the diagnosis certain? The disease is easy to diagnose, with a simple scraping of the sore. If the diagnosis is certain, then a decision to treat is based on the form and severity of the disease and where the infection was acquired. All cases of the visceral form should be treated, but sometimes small, localized skin lesions do not need treatment. However, with cases acquired in Latin America, a simple cutaneous lesion can sometimes lead to a mucous-membrane form of leishmaniasis. This involves the tissues of the nose and mouth and can be quite disfiguring. To prevent this complication, all cutaneous disease of the "New World" type should probably be treated. I recommend your wife discuss her diagnosis and treatment with a specialist in infectious disease.