_______________________________________________________________________________________________________________________________ Open Access Maced J Med Sci. 2018 Jan 25; 6(1):89-92. 89 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2018 Jan 25; 6(1):89-92. Special Issue: Global Dermatology-2 https://doi.org/10.3889/oamjms.2018.028 eISSN: 1857-9655 Case Report Cutaneous Leishmaniasis – A Case Series from Dresden Uwe Wollina 1* , André Koch 1 , Claudio Guarneri 2 , Georgi Tchernev 3,4 , Torello Lotti 5 1 Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Germany; 2 Department of Clinical Experimental Medicine, Unit of Dermatology, at the University of Messina (Italy), C/O A.O.U. “G. Martino”, via Consolare Valeria, 1, 98125 Messina, Italy, 3 Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria; 4 Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria; 5 University of Rome G. Marconi, Institute of Dermatology, Rome 00186, Italy Citation: Wollina U, Koch A, Guarneri C, Tchernev G, Lotti T. Cutaneous Leishmaniasis – A Case Series from Dresden Open Access Maced J Med Sci. 2018 Jan 25; 6(1):89-92. https://doi.org/10.3889/oamjms.2018.028 Keywords: Leishmaniasis; Protozoa; Cutaneous infection; Traveler’s diseases; Displaced people *Correspondence: Uwe Wollina. Stadtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany. E-mail: wollina- uw@khdf.de Received: 08-Aug-2017; Revised: 06-Sep-2017; Accepted: 07-Sep-2017; Online first: 10-Jan-2018 Copyright: © 2018 Uwe Wollina, André Koch, Claudio Guarneri, Georgi Tchernev, Torello Lotti. This is an open- access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) Funding: This research did not receive any financial support Competing Interests: The authors have declared that no competing interests exist Abstract Leishmaniasis is world-wide one of the most common infectious disorders caused by protozoa. Due to the climate change, there is a risk of further spread of the disease to central and northern Europe. Another important issue is the high number of refugees from Syria since Syria is one of the hot spots of Old World leishmaniasis. We report on single-centre experience with leishmaniasis in the capital of Saxony, Dresden, during the years 2001 to 2017. We noted a substantial increase in the last five years. Once a very rare exotic disorder in Germany, cutaneous leishmaniasis has become a reality and physicians should be aware of it. A significant number of cases are from Syrian refugees; other cases had been acquired by tourists in the Mediterranean region! Introduction The climate change has the potential for distribution and epidemiology of skin diseases. In case of infectious dermatoses, climate may modulate the distribution of both, pathogens and vectors [1]. Leishmaniasis is a protozoal disease with cutaneous, mucocutaneous and visceral subtypes. World-wide, about two million people are affected. Pathogens are Trypanosoma-like Leishmania with the major subgenera Leishmania and Viannia. Around 20 species have been identified so far. Cutaneous leishmaniasis is classified into Old World- and New World- disease. Also, there is mucocutaneous and visceral leishmaniasis, also known as Kala-Azar [2]. The classical distribution of leishmaniasis is Central and South Americas, China, Sri Lanka, the Indian subcontinent, North, East, West and Central Africa, Middle East, and the Mediterranean. Transmission occurs by blood-sucking female insects of the genus Phlebotomus (Old World) and Lutzomyia (New World). Pathogen reservoir includes rodents, canine, feline, and humans. The incubation period may vary between some weeks and several months. The protozoa are located intracellular and modify the host response reactions immunologically [3]. Entomological investigations suggest changes in the geographical distribution of Leishmania vectors. An increased risk for vectors has been calculated for the European Atlantic coast, Austria, Germany, and Switzerland [4]. In Germany, there are two possible mosquito vectors, i.e. Phlebotomus (P.) mascittii and P. pernicious [5]. In Northern Italy, Ixodes ricinus had been identified as another possible vector since 7.5% of all tick bites had a positive polymerase chain reaction (PCR) for Leishmania (L.) infantum [6]. PCR plus sequencing and/ or multiple restriction enzyme