# An assessment of interobserver agreement on lesion size, morphology and clinical phenotype in cutaneous leishmaniasis caused by Leishmania aethiopica in Ethiopia

## TL;DR

This study examines how consistently doctors assess skin lesions in leishmaniasis patients in Ethiopia, finding that lesion size is reliable while other features vary.

## Contribution

The study provides empirical evidence on interobserver agreement in CL assessments, highlighting lesion size as a reproducible outcome measure.

## Key findings

- High consistency in reporting major lesion morphology categories like plaques.
- Significant variability in secondary features such as dyspigmentation and mucosal involvement.
- Lesion size measurements showed limited variability, suggesting reliability for clinical trials.

## Abstract

Cutaneous leishmaniasis (CL) remains a major public health challenge, especially in endemic regions like Ethiopia, where an estimated 40,000 new cases occur annually. Effective treatment evaluation for CL relies on consistent clinical assessments, yet variability in lesion descriptions can complicate reliable outcome measures.

We conducted an inter-reliability study of clinicians’ evaluations of CL lesion morphology and size at ALERT Hospital, Addis Ababa. Twelve clinicians independently examined 12 patients with parasitologically confirmed CL, each clinician assessing lesion morphology, size, and severity.

We found high consistency in reporting major morphological categories (e.g., plaques) but significant variability in secondary features like dyspigmentation and scale, as well as mucosal involvement. Lesion size measurements showed limited variability, suggesting its reliability as a potential measure for future clinical trials. Disparities in severity assessments highlight the need for a standardized scoring system in CL.

Our findings underscore the importance of training for consistent, high-quality clinical evaluations of CL and suggests that lesion size could be a reproducible outcome measure in treatment efficacy trials.

Cutaneous leishmaniasis is a significant public health issue in Ethiopia, with around 40,000 new cases each year. The disease can cause a wide variety of different types of skin lesions which can complicate diagnosis and assessment. Conducting reliable treatment evaluation requires consistent assessment of cutaneous leishmaniasis lesions, especially in clinical trials.

We conducted a prospective study at ALERT Hospital in Addis Ababa to assess how consistently 12 clinicians, who were all experienced in managing patients with cutaneous leishmaniasis, evaluated the appearance, size and severity of cutaneous leishmaniasis lesions in 12 patients.

We found that whilst clinicians were broadly consistent in identifying the major features such as the type of lesions they showed more significant variability in describing secondary features and severity. Lesion size measurements were more consistent, making them a promising tool for future clinical trials. The findings highlight the need for better training and standardized scoring systems to improve the reliability of clinical evaluations in cutaneous leishmaniasis.