Clinical, laboratory, and therapeutic characteristics of cutaneous leishmaniasis: 15-year incidence in Crete and Greece, and implications for clinician awareness

Background: Cutaneous leishmaniasis (CL) is an under-recognised parasitic disease in southern Europe, where heterogeneous clinical presentations and limited clinician familiarity can contribute to delayed diagnosis. Method: We conducted a 15-year retrospective case-series study at a tertiary-care referral hospital in Crete, Greece, to describe the epidemiological, clinical, laboratory and therapeutic characteristics of confirmed CL cases. Results: Twenty-five patients were identified, including two with concomitant visceral leishmaniasis. Most presented with solitary, painless lesions on exposed sites, and the median duration of skin lesions before diagnosis was 327 days, highlighting a substantial diagnostic delay. PCR was the most sensitive diagnostic tool, followed by histopathology and culture, while species identification confirmed Leishmania tropica in selected CL cases. Treatment approaches varied, including systemic agents, topical therapies and observation. Failure and relapse rates were 12% and 16%, respectively, and occurred mainly in patients with significant comorbidities or immunosuppression. Conclusion: The island of Crete is a persistent epicenter of CL in Greece, with a low apparent incidence but notable clinical complexity. Delayed recognition and heterogeneous diagnostic pathways underscore the need for improving clinical awareness and implementing clearer diagnostic algorithms.