Body location of New World cutaneous leishmaniasis lesions and its impact on the quality of life of patients in Suriname

Cutaneous leishmaniasis (CL) is a chronic skin infection caused by Leishmania parasites, causing single or multiple skin nodules and ulcers on the exposed body locations. Healing of lesions is followed by scar formation. Active and healed CL lesions may affect patient's health related quality of life (HRQL). The aim of this study was to determine whether the body location of the leishmaniasis lesions affects the HRQL of localized CL patients in Suriname. The HRQL of 163 patients with CL was assessed by Skindex-29 and EQ-5D/VAS questionnaires. Forty-six patients out of the total study population also participated in a qualitative anthropological study involving in depth interviews. All patients were allocated in 4 groups in the following hierarchy: head and face, upper limbs, lower limbs and trunk. Patients with lesions on the lower limbs had significantly higher Skindex-29 scores, indicating worse HRQL, in the symptom scale compared to lesions on head/face and trunk. The lower limb group was more likely to report problems in the dimensions self-care, mobility, daily activities and pain/discomfort of the EQ-5D. Little to no social stigma was reported in the in-depth interviews. The findings of this study indicate that Surinamese patients with CL lesions located on the lower limbs had more impairment in HRQL than on other body locations. Stigma related to CL seems to be virtually absent in Suriname. Author summary Cutaneous leishmaniasis (CL) is a parasitic skin infection characterized by one or more skin lesions. Depending on the location of the lesions, patients may experience difficulties in their day-to-day life including stigma. The aim of this study was to evaluate the quality of life of CL patients with lesions. We collected the data among 163 CL patients with two different questionnaires assessing various parts of their quality of life; 46 patients provided additional information through in depth interviews. All patients were divided in four groups according to location of lesions on the body: head and face, upper limbs, lower limbs, and trunk. We found that patients experienced more difficulties when lesions were located on the lower limbs. Little to no social stigma was reported in the in-depth interviews. The study concluded that Surinamese patients with lesions on the lower limbs had a lower quality of life compared to other body locations.