Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2023;13(2):e2023087 1 Erysip eloid Presentation of Cutaneous Leishmaniasis of the Scalp Awatef Kelati1, Mouna Rimani2 1 Dermatology department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco 2 Department of Pathological Anatomy Hassan, Rabat, Morocco Citation: Kelati A, Rimani M. Erysipeloid Presentation of Cutaneous Leishmaniasis of The Scalp. Dermatol Pract Concept. 2023;13(2):e2023087. DOI: https://doi.org/10.5826/dpc.1302a87 Accepted: September 14, 2022; Published: April 2023 Copyright: ©2023 Kelati et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Kelati Awatef, Dermatology Department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco. E-mail: akelati@um6ss.ma Case Presentation A 39-year-old man from the area of Tinghir in Morocco, was referred to the Dermatology consultation with a 6-month his- tory of mild itchy skin lesions of the forehead. The physical examination showed an extensive erythematous infiltrated plaque of the forehead and the fronto-temporal area. Der- moscopy revealed perifollicular scales, yellow dots, follicular keratotic plugs, and branching vessels on an erythematous orange background (Figure 1). After a negative slit-skin smear, which was performed because of the high frequency of leishmaniasis in that endemic area of Morocco, and be- cause of the suggestive dermoscopic appearance especially the yellow dots and plugs on an orange-erythematous back- ground. Skin biopsy showed diffuse tuberculoid granuloma- tous infiltrate without caseous or fibrinoid necrosis, with the presence of Leishman bodies (Figure 1), which confirmed the  diagnosis of granulomatous cutaneous leishmaniasis. The  identification of parasite species by PCR was not per- formed. Meglumine antimoniate was out of stock at that period, so, we prescribed doxycycline and aureomycine oint- ment for 12 weeks, with a significant amelioration, then the patient received intramuscular  injection of glucantime for 20  days because of the persistence of a slight erythema, a complete remission was then achieved. Teaching Points Cutaneous leishmaniasis (CL) can have atypical clinical pre- sentations with sometimes a negative slit-skin smear, espe- cially in chronic granulomatous presentations, however, CL could be highly suspected on dermoscopy. Follicular kera- totic plugs, generalized erythema with vascular structures are the most common dermoscopic features [1]. The diagno- sis confirmation relies on the skin smear or histopathology findings [2]. 2 Image Letter | Dermatol Pract Concept. 2023;13(2):e2023087 Figure 1. (A) Cutaneous leishmaniasis. Extensive erythematous infiltrated plaque of the forehead and the fronto- temporal area. (B) Dermoscopy revealed perifollicular witish scales and erythema (green arrow), yellow dots ( yellow ar- rows), follicular keratotic plugs (gray circle), and branching vessels (red arrow) on an erythematous orange background. Histopathology (C, H&E) and Giemsa Stain (D): diffuse tuberculoid granulomatous infiltrate without caseous or fibrinoid necrosis, with the presence of Leishman bodies. Magnification x 400. References 1. Serarslan G, Ekiz Ö, Özer C, Sarıkaya G. Dermoscopy in the Diagnosis of Cutaneous Leishmaniasis. Dermatol Pract Con- cept. 2019;9(2):111-118. DOI:  10.5826/dpc.0902a06. PMID: 31106013. PMCID: PMC6502294. 2. Garcias-Ladaria J, López-Brito K, Pascual-López M, Rocamora V. An itching plaque. Dermatol Pract Concept. 2015;5(1):51-53. DOI:  10.5826/dpc.0501a09. PMID: 25692083. PMCID: PMC4325692.