Cutaneous leishmaniasis is considered as an endemic parasitic infection in certain areas of Libya. One of these established areas is Gharian province. One hundred and forty cutaneous leishmaniasis cases were recorded in Gharian outpatient polyclinic during the period from December 2007 to May 2008. Of these cutaneous leishmaniasis cases, sixty seven cases were children and seventy three cases were adults. The infection was clinically diagnosed and confirmed by the demonstration of Leishmania parasite on smears from lesion biopsies. These Cutaneous leishmaniasis (CL) cases were classified according to the gender and age. We found that the percentage of infected male children and adult cases (58.20% and 56.16% respectively) was more than that of the infected female children and adult cases (41.79% and 43.84% respectively).We observed that the highest number of the infected children cases was within 10 - 14 years age group of both sexes, while the highest number of affected adults was within 25 - 35 years age group of both sexes. The study of geographical distribution of both children and adult CL cases within Aljabal Algharbi subprovinces revealed that the majority of both children and adult CL cases have been reported from Al-kawasem subprovince, while there was difference in the geographical distribution of minority of both adult and children CL cases. The majority of the reported children CL were school children while the minority was preschool children. In adults, the majority of adult CL cases were officers, students and housewives,while the minority of adult Cl cases were nurses. In children, the percentage of the CL cases that had single and multiple lesions was approximately equal. On the other hand, the percentage of the adult CL cases that had multiple lesions was more than the percentage of the adult CL cases that had single lesions. We observed that the pattern of distribution of CL lesions was different between children and adult cases. In children, it was found that the face was the most affected part in male and female cases; the upper and lower extremities were the moderately affected parts in both sexes, while the least affected part in male and female cases was the back. In contrast, in adults, it was found that the most affected parts in male and female cases were the upper and lower extremities, while the face and neck were the least affected parts in male and female cases. There was three clinical presentations of the disease in this study; nodular, ulcerated nodular and crusted nodular. In children and adults, the majority of the CL cases had ulcerated nodular lesions, while the minority of the CL cases had crusted nodular lesions. All reported cutaneous leishmaniasis have been treated. The majority of the CL cases have been treated with only local liquid nitrogen cryotherapy, while the minority was treated with antimony compounds. The cutaneous leishmaniasis cases in this study showed various clinical patterns, different types of lesions and various geographical distributions. This suggests that there may be more than 2 on species of Leishmania responsible for the cutaneous leishmaniasis infection among people of Al-jabal Al-gharbi province. This needs further study to identify the species of Leishmania responsible for the disease. 

 Cutaneous leishmaniasis (CL) is an endemic parasitic infection in the Mediterranean region, including Libya and 

its Al-jabal Al-gharbi province. We aimed at studying the occupational relevance as well as other epidemiological aspects 

of CL. We investigated 140 CL cases who attended at Gharyan outpatient polyclinic during a period of 6 months in 2009. 

CL infection was clinically diagnosed and confirmed by demonstration of Leishmania parasites on smears from lesions. 

Our findings showed that males were more affected than females (P=0.04), and people above 10-years were more af￾fected than younger ones (P=0.0001). A significant percent of CL cases belonged to Al-Kawasem subprovince 

(P=0.0001). Farm-related activities were the most frequent occupations among CL cases (P=0.04). In addition to farm 

workers, housewives and students are at risk groups since they are engaged at farm activities. Moreover, those who have 

occupations that require staying outdoors for a part of night, e.g., policemen, are also at risk. Compared to children, adult 

CL patients had multiple lesions (P=0.001) that were more prevalent in their upper and lower extremities than the face 

(P=0.0001). We conclude that CL is a major health problem in Al-jabal Al-gharbi province of Libya. The presence of ro￾dents and sandflies makes it a suitable environment for Leishmania to spread in an endemic epidemiological pattern. Be￾ing engaged in farming activities or outdoor occupations increases the risk of infection. Various clinical patterns of CL 

suggest the presence of more than 1 species of Leishmania at Al-jabal Al-gharbi province. We propose that the 2 species 

responsible for CL in this area are L. major and L. tropica. Further investigations to identify the leishmanial species re￾sponsible for CL at Al-jabal Al-gharbi together with adoption of preventive and control programs are needed.

23 years old man presented with 15 years history of persistent painless thickening of skin of the dorsal and lateral aspects of the proximal interphalangeal joints of both hands, no family history of similar illness, X-ray of both hands shows only soft tissue swelling, and histopathological examination shows hyperkeratosis, acanthosis, and dermal collagen bindles.