The characteristic skin hyperpigmentation is thought to be caused by melanocyte stimulation and xerosis caused by leishmania infection. 

A preliminary study (International Journal of Science Commerce and Humanities Volume No 2 No 5 July 2014, 86: Elevated cortisol level due to visceral leishmaniasis and skin hyperpigmentation are causally related, Elawad Bahaeldin ELkhair), states that "skin hyper-pigmentation in patients with visceral leishmaniasis can be attributed to cortisol. Patients with visceral leishmaniasis have high level of cortisol. Within the context of pathogenesis of visceral leishmaniasis several cytokines such as tumor necrosis factor and interleukins are produced. It seems that

the hypothalamo-pituitary-adrenal axis is stimulated by these cytokines. Stimulation occurs at the level of hypothalamus and/or pituitary gland with subsequent increased production of adrenocorticotropic hormone which could be responsible for skin hyper pigmentation. ACTH induces secondary hypercortisolism which is responsible for

the high level of cortisol in patients with visceral leishmaniasis. Treatment with pentostam is associated with dramatic reduction of cortisol and disappearance of skin hyper-pigmentation. Whether pentostam directly inhibits hypothalamo-pituitary adrenal axis or interacts with the immune system to produce certain substances (regulatory molecules) that inhibit the axis remains to be conclusive."

Dear  Gianni Colotti I agree with  your

amazing comprehensive  report and thanks for it

Thanks Gianni Colotti for this answer. It sheds light on this important aspect of leishmaniaisis.

Dear Dr Colotti,

that was most productive and detailed explanation and thank you for that. I perfectly got what I was looking for...

hello doctor

Pigmentation is commonly observed in the patient of CL, VL

and PKDL. Various pigmentation patterns are seen in the person

suffering from Leishmaniasis. Pigmentation is the colouring of

individual skin. When a person is healthy, his or her skin will appear

normal in colour. In the case of Leishmania infection, the person’s

skin may change colour, becoming darker (hyperpigmentation) or

lighter (hypopigmentation) or sometimes total loss in skin colour

(depigmented). Hyperpigmentation in skin is caused by an increase

in the melanin pigment (responsible for colour of skin). Melanin

pigment is found in a special type of cell named as melanocytes. Hypo

pigmentation  is decrease in the pigment of skin or lightening of the

skin. Hypopigmentation in skin is the result of a reduction in melanin

production.

This is possibly related to incresed cortisol effect

Thanks Gianni Colotti for this answer

Due to high production of adrenocorticotrpic hormone