Question: i have travelled to belize , recently from usa have developed the lesions in photo on my arms and legs the friends in belize say it is cutanious leishmaniasis my dermatologist in us does not know what it is treated with topical steroid cream no improvement new lesions are coming up on my body

Below is more detail on my case. I travelled to Belize with my family (my wife and two young daughters) from Dec 28th- XXXXXXX 12th. We had fun there and spent time and the beach and in the jungle. I was bitten constantly by sand flies while I was there despite initially putting on plant based bug repellent and when that did not work DEET. My wife and kids did not seem to be bitten as much. I has hundreds of bites while they might have had a few at most. The sand fly bites healed in about three weeks after I got back. I then started getting very itchy bumps on my legs and went to see my dermatologist who diagnosed it as atopic dermatitis and put me on a oral course of prednisone 40 mg for 5 days to get down the inflammation. He did a skin scraping when the raised a possibility of scabies in the web of my fingers. I did not have any bumps of lesions in that area and still XXXXXXX not and did not find anything. That seemed to help a little but the bumps and by now scabby sores never went away and got worse after a week after the oral steroid treatment. He then did a biopsy of two of the spots and the report came back as either insect bite or scabies. He as a precaution put me on 1 dose of oral ivermectin as well as topical premethrin 5% cream that I applied all over my body except face and scalp for 16 hours. He also prescribed topical fluocinonide that I have also been using since. He said that ivermectin should be enough to get the scabies. I looked up CDC protocol and they recommend another treatment after 10 days. So I asked him to prescribe another dose of ivermectin and premethrin. He said he was not comfortable doing premethrin again but gave me another does of ivermectin. I was getting new spots and most of my old spots were not healing and had enlarged. I called back (this is now about three weeks after the biopsy) and he prescribed another dose of ivermectin and this time premethrin cream as well. I then went to a followup with him about ten days ago. He said I have been adequately treated for scabies and that in his opinion this is atopic dermatitis that should be treated with steroids which did not do much for me. I have a history of asthma which the same doctor has treated me for asthma (his speciality is allergy, ashtma and dermatology) for the past fifteen years. I have been on oral steroids three or four times before for bad episodes in the previous fifteen years and they work well for me. They did not in this case. The topical steroid seems to help some but the sore and the itching never seems to go away. He said I should go to the University hospital to get a second opinion. I have an appointment with a dermatologist on the 17th of April. Yes I do have a lot of itching. It is worse while going to bed and when I shower. I will upload some more pictures of both legs and the arm where I have lesions and also the new spots that are now appearing on my shoulders and chest. I tried uploading more pictures. But it allows me to upload only one more. So I uploaded the most relevant. The new one show lesions on my left leg. The first one is on my right leg. Both of these show lesions that have not healed in nearly two months.

Thanks for your response doctor. I take ceterizine hydrochloride 10 mg everyday as maintenance for my nasal allergies and ashthma. So I am already on an antihistamine. They don't seem to prescribe oral antibiotics as readily here in the US. I was told to apply polysporin as needed which I do a few times a day. Your diagnosis meshes with my allergists. I am glad you have ruled out CL. I wanted an opinion from someone who has treated CL and has seen in often in practice. It is something that is rarely seen in the US and the doctors here have no experience with it. I have traveled in an area where CL is endemic and have been bitten hundreds of times by the vector that causes CL. So I wanted to be sure. Thanks!