Episode 39 - Ethiopia cutaneous leishmaniasis cohort

In this episode of BJD Talks, Sam and Meera discuss the article ‘Clinical and patient-reported outcomes of cutaneous leishmaniasis treatment in Ethiopia: a prospective observational cohort study from two referral hospitals’ by Doni et al. The full article can be accessed at https://doi.org/10.1093/bjd/ljag061

*This podcast was generated by an AI tool created by 67Bricks for the British Association of Dermatologists*

Transcript

Sam: Welcome to BJD Talks, the official podcast of the BJD. I'm Sam.

Meera: And I'm Meera. In this episode we will be discussing the article by Shimelis Nigusse Doni et al, 'Clinical and patient-reported outcomes of cutaneous leishmaniasis treatment in Ethiopia: a prospective observational cohort study from two referral hospitals,' from February 2026 and included in the June 2026 issue.

Sam: Cutaneous leishmaniasis, or CL, continues to be a major global health issue, especially in resource-limited settings like Ethiopia. With forty thousand new cases annually, it’s one of the most persistent neglected tropical diseases. Perhaps we should start by outlining the disease.

Meera: Of course. CL is a skin disease caused by Leishmania parasites, primarily Leishmania aethiopica in Ethiopia. It presents in three main forms: localized cutaneous leishmaniasis, mucocutaneous leishmaniasis affecting mucosal tissues, and the severe, treatment-resistant diffuse cutaneous leishmaniasis. These forms often leave scars or ulcers, significantly affecting a patient’s quality of life.

Sam: Indeed. This study sought to evaluate treatment outcomes in Ethiopia, where sodium stibogluconate is widely used. Despite the disease burden, these outcomes are poorly understood.

Meera: To address this, researchers tracked six hundred and sixty-six patients from two referral hospitals—ALERT in Addis Ababa and Boru Meda General Hospital in South Wollo—over eighteen months. Outcomes were measured clinically, such as lesion healing, and through quality-of-life tools like the Dermatology Life Quality Index and EQ-5D-5L, with day ninety as a key follow-up point.

Sam: The findings were stark. Only twenty-eight point three per cent of localized cases and twenty-three point five per cent of mucocutaneous cases were cured by day ninety. For diffuse cases, this figure dropped to eight per cent. Although many patients reported some improvement, quality-of-life scores revealed lingering scars, unresolved lesions, and persistent pain.

Meera: The side effects were also notable. Eighty-one point four per cent of participants experienced reactions, ranging from injection site pain to nausea. While none were life-threatening, the side effects remain a significant burden.

Sam: Another issue was treatment inconsistency. Both hospitals used sodium stibogluconate as their main therapy, but dosing varied, adjunct treatments like cryotherapy differed, and clinician preferences introduced variability, complicating broader conclusions.

Meera: Exactly. The study also highlighted the importance of large-scale randomised trials for newer drugs like oral miltefosine, which shows potential but currently has middling cure rates. Broader challenges, like delayed healthcare access and reliance on traditional healers, further impact outcomes.

Sam: Decentralising care could help, perhaps moving diagnosis and treatment from referral hospitals into communities. Catching cases earlier, when lesions are smaller, might improve outcomes. What else stood out to you, Meera?

Meera: For me, it’s the gap between clinical outcomes and patient experiences. Lesions might heal technically, yet scars, stigma, and psychological effects often persist. The EQ-5D-5L wasn’t sensitive enough to capture the emotional burden or social impacts but the team did find that skin specific measures of quality of life were more useful. 

Sam: A good point. In summary, CL treatment in Ethiopia faces serious challenges, with poor cure rates and significant side effects. Improving outcomes will require not just new therapies, but systemic healthcare changes.

Meera: Well said. And with that, we bring this episode of BJD Talks to a close. Thank you for joining us, and keep striving in your important work.

Sam: Thank you, everyone! See you next time on BJD Talks. Stay curious, and stay informed.