“Aleppo Evil” قرحة حلب : The Ulcer, the Boil, the Sandfly, and the Conflict

Even in the best of times the Syrian Arab Republic (Syria) has struggled with cutaneous leishmaniasis (CL). We reported previously in PLOS Neglected Tropical Diseases that old world or anthroponotic CL caused by Leishmania tropica is endemic to Syria and elsewhere in the Middle East, North Africa, and Central Asia. In the ancient northern Syrian city of Aleppo CL has been present for hundreds of years (if not longer), where it is known as the “Aleppo Evil”, “Aleppo ulcer”, “Aleppo Boil”, or “Aleppo Button”. Aleppo evil is a disfiguring condition that disproportionately occurs on the face, especially of young people. It typically lasts one or two years before the lesion heals spontaneously, and is often known locally as “one-year sore”. However, in many cases specific anti-parasitic chemotherapy can hasten the healing process and improve clinical and cosmetic outcomes.

A major problem with one-year sore is that the scar can produce permanent disfigurement of the face.  According to some experts working in Afghanistan old world CL is a cause of social isolation and stigma particularly among girls and young women who can be rendered unmarriageable. Mothers with CL may not be allowed to touch their children even though human to human contact does not transmit the infection.

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