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Mid‐dermal elastolysis with prothrombotic abnormalities: two cases

became much worse, her eczema also greatly improved. Her UVA1 phototherapy was discontinued 1 month after her course of stibogluconate had finished and while under review 8 months subsequently, there was no evidence of systemic illness. We believe that this case is interesting for several reasons. Firstly, it is a reminder of the importance of obtaining a complete previous medical history and travel history in diagnosing certain diseases, such as leishmaniasis, that can show late recurrence. Secondly, the diagnosis was made more difficult by her concomitantly having severe atopic dermatitis. Leishmaniasis proving difficult to diagnose in the presence of atopic dermatitis has been reported before in a case series from Saudi Arabia. We suspect that the systemic and topical corticosteroids that she required for her atopic eczema played a part in cutaneous recurrence of her leishmaniasis. The problem was present before she even started UVA1 phototherapy and so we are unsure as to whether or not this played any part in its pattern of presentation. It is of interest that her eczema flared towards the end of her course of antileishmanial systemic therapy, but then very markedly improved, raising the possibility of an immune response to release of antigen from killed Leishmania organisms.