Post-kala-azar dermal leishmaniasis (PKDL), a sequel to kala-azar mainly caused by Leishmania donovani is endemic in the eastern part of India and the adjoining countries of Bangladesh and Nepal. The importance of tracking this infection is vital for the eradication of kala-azar. It is important to note that PKDL can occur as long as 20 to 30 years after the episode of visceral infection. The impact of adequate therapy of kala-azar on the occurrence of PKDL remains unclear. The diverse clinical

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... manifestations of PKDL continue to evade clinicians. Unfortunately the recognition and classification of this dermatosis remains unsatisfactory. Traditional methods like slit-skin smear and histopathology supplemented by history are not sensitive since Leishman-Donovan bodies may not be demonstrable in a significant number. Immunohistochemical and culture facilities are infrequently available and need expertise. Recent studies have resorted to the use of rk39 strip test and PCR/qPCR to confirm the diagnosis. However the routine availability of these tests needs much improvement even in the endemic areas. Awareness of PKDL in non-endemic areas is to be increased as kala-azar has also been reported from some of these places. Little has been done to devise good therapeutic regimens to treat PKDL. The antimony era proved very bad with gradually increasing doses of parenteral antimony leading to a state where complications outran benefit. Further the development of antimony resistance finally put an end to this era. Oral miltefosine made a breakthrough in the beginning of this century and is currently the recommended drug for this condition. The development of resistance and high incidence of gastrointestinal side-effects following increased or prolonged dosage are major deterrents. Trials are being conducted with liposomal amphotericin to optimize the dose and duration in PKDL. The greatest problems confronting clinicians in the use of these two drugs, miltefosine and liposomal amphotericin, is the availability, cost and hospitalization in case of the latter. Combination therapy is a powerful tool that has still to be explored. This critical juncture when kala-azar appears to be on the wane signals the need for better drugs and diagnostic facilities to effectively keep PKDL under control. http://dx.