داء الليشمانيا الجلدي المعقد عندما لا يحقق العلاج الجهازي الأولي المضاد للليشمانيا استجابةً كافية

References

DOI: 10.1093/cid/ciw670

Systemic treatment is recommended for persons with complex CL as defined in Table 1.

Less common cutaneous syndromes, such as leishmaniasis recidivans (caused by L. tropica and occasionally other species), diffuse cutaneous leishmaniasis (caused by L. mexicana, L. amazonensis, and L. aethiopica), and disseminated cutaneous leishmaniasis (caused by L. [V.] braziliensis), usually require systemic therapy.

Additional therapy is recommended (but not necessarily always with a different agent or approach) when there is development of new skin lesions or worsening of existing lesions.

Relatively little improvement or worsening while on therapy suggests an inadequate response, and an alternate treatment approach should be planned.

By 4–6 weeks after treatment, the lesion size should have decreased by >50%, ulcerative lesions should be reepithelializing, and no new lesions should be appearing.

Ulcerative lesions are generally fully reepithelialized and clinically healed by approximately 3 months after treatment.