During VL, interferon gamma is not produced by peripheral blood mononuclear cells (PBMC). After treatment of VL, PBMCs start producing interferon gamma, which coincides with the appearance of PKDL lesions due to interferon-gamma-producing cells causing skin inflammation as a reaction to persisting parasites in the skin. Diagnosis
PKDL is difficult to diagnose.Diagnosis is mainly clinical, but parasites can be seen by microscopy in smears with limited sensitivity. PCR and monoclonal antibodies may detect parasites in more than 80% of cases. Serological tests and the leishmanin skin test are of limited value. Treatment
Treatment is always needed in Indian PKDL; in Sudan, most cases are self-limited but severe and chronic cases are treated. Sodium stibogluconate is given at 20 mg/kg for 2 months in Sudan and for 4 months in India. Liposomal amphotericine B seems effective. Although research has brought many new insights in pathogenesis and management of PKDL, several issues in particular in relation to control remain unsolved and deserve urgent attention.Miltefosine is the only available oral medication available for VL and PKDL. While the drug works for short-term treatment of VL, PKDL would require a longer treatment of more than 28 days with this drug. Miltefosine is not recommended for use as a monotherapy to treat PKDL. Society and culture
People with PKDL are a reservoir of leishmaniasis. To eliminate leishmaniasis from a population, people with PKDL must get treatment.The government of India has an kala-azar elimination program ongoing which entered a consolidation phase in 2017. See also
List of cutaneous conditions


== References ==
Extraction might be contraindicated and might be simple or surgical, often depending on the location of the teeth. In some cases, for aesthetic purposes, a surgeon may wish to expose the canine. This may be achieved through open or closed exposure. Studies show no advantage of one method over another. Laser can be used to uncover superficially impacted teeth with no bleeding and quick recovery

References
See also
Impacted wisdom teeth