This study investigates the prevalence and distribution of Cutaneous Leishmaniasis (CL) in Tehsil Adenzai, District Dir Lower, Khyber Pakhtunkhwa, from August 2023 to February 2024, reporting a total of 1388 cases. The findings revealed a notable gender disparity, with males (82.95%) being predominantly affected, compared to females (18.05%), likely due to higher outdoor exposure and occupational risks. Age-wise, the highest prevalence was observed among individuals aged 0-15 years (36.17%). Geographically, the hotspots were identified as Badwan and Chakdara, with 432 and 341 cases, respectively. Lesion analysis indicated that most patients presented with dry lesions (76.15%), and the face was the most commonly affected site (37.78%). Risk factors such as recent travel history (76.94%), rural residence (58.65%), and proximity to domesticated animals (88.76%) were significantly associated with CL transmission. Moreover, species distribution patterns showed Leishmania tropica as the most prevalent, followed by Leishmania major and Leishmania infantum, each exhibiting distinct geographical and occupational predilections. The results highlight the urgent need for targeted interventions, especially for high-risk groups, through enhanced vector control, community education, and improved housing conditions to mitigate CL transmission.