A skin disease caused by a sand fly is on the rise in parts of Khyber Pakhtunkhwa.

Leishmaniasis, the scientific name of the disease, is caused by parasites of the Leishmania type and spread by the bite of certain types of sand flies.

At least 21,000 people have reportedly fallen prey to the disease in the province in just a span of a year.

Doctors Without Borders calls leishmaniasis one of the most dangerous and neglected tropical diseases, according to the HealthLine website.

It is caused by the Leishmania parasite that typically lives in infected sand flies. The infected sand flies are usually found in tropical and subtropical environments. Parts of Asia, East Africa, and South America have witnessed the outbreaks of this disease in the past.

Related: Over 554 sand fly bite cases reported in Khyber Pakhtunkhwa’s Karak

Among seven tribal areas, Khyber is the most affected district, where 9,378 cases have been reported so far. Mohmand is the second high alert area where 5,373 cases have been reported. North Waziristan and South Waziristan are also affected with 443 and 354 patients of this skin disease. As many as 225 people were tested positive in Kurram and 163 and Orakzai.

Similarly, many patients in 10 other districts are also suffering from Leishmaniasis.

The health department of the provincial government has set up 15 centres in seven tribal districts. The sand fly carrying the parasites of the disease traveled all the way from Afghanistan, doctors say.

Doctors have called upon the public to keep their environment clean.

Looking for signs

A sand fly looks like a common mosquito. But it inserts venom into the human skin with a sting. It takes two to four months before inflammation starts. The patient’s skin gets frequently dry and no creams, lotion or ointment helps it.

“The disease starts with minor and painless red acne,” a dermatologist, Dr Irfan, told SAMAA TV. “The acne seems harmless initially. But it continues to spread.”

The doctors prescribe an antibiotic injection to be administered once or twice a day. The treatment lasts for three weeks. No immunity vaccine for the disease is available at the moment.

“The vaccine is not available in the market,” said Dr Shaheen, a spokesperson of the health department. “The ones which we have demanded from the World Health Organization is Rs600 per vial.”

The disease has three types: cutaneous (most common), mucocutaneous, and visceral leishmaniasis [most serious and known as kala-azar].

The cutaneous type forms skin ulcers. Mucocutaneous type triggers ulcers of the skin, mouth, and nose, Meanwhile, the visceral type begins with skin ulcers and later develops with fever, low red blood cells, and enlarged spleen and liver.

The disease can be diagnosed by seeing the parasites under a microscope. However, the visceral type can be diagnosed with blood tests as well.

Over 20 species of Leishmania cause infections in human beings.