A parasitic skin disease that causes disfiguring facial sores and boils is quickly spreading in the besieged Syrian city of Aleppo, with children disproportionately affected. Cutaneous leishmaniasis (CL) has been a health threat for hundreds of years in Aleppo, where it is known as the "Aleppo evil," "Aleppo ulcer," or "Aleppo boil," writes disease and poverty fellow Peter J. Hotez in the PLOS Blog. "It should come as no surprise that this disease would re-emerge with a vengeance as a result of a horrific civil war" and a breakdown in infrastructure and public health control measures.

While there are few, if any, official public health accounts of CL, news reports indicate the number of cases in Aleppo and surrounding areas could range "into the thousands or possibly even the hundreds of thousands," Hotez says.

In times of peace, the spread of CL -- which is transmitted by sand flies -- can be controlled through sanitation, insecticidal spraying, and increased use of insecticide-treated nets. Unfortunately, the ongoing hostilities in Syria portend continued public health inaction, Hotez writes. "Perhaps at a minimum the international community for now needs to focus on refugees and refugee encampments to ensure local control and patient access to treatments."

Read "'Aleppo Evil': The Ulcer, the Boil, the Sandfly, and the Conflict" in the June 5, 2013, edition of the PLOS Blog.