Cutaneous Leishmaniasis Caused by L. braziliensis or L. peruviana — When Local Treatment Has Not Achieved Complete Healing
This protocol covers the next therapeutic step for patients with cutaneous leishmaniasis caused by Leishmania braziliensis or Leishmania peruviana in whom a prior course of local therapy did not result in complete reepithelialization of the lesion.
Species context: L. braziliensis and L. peruviana are genetically very similar species. Their identification shapes which treatment pathway applies and which region-specific options are available.
Previous Treatment — Failure Condition
Prior local therapy: Local infiltration with antimonials (with or without cryotherapy), topical paromomycin/methylbenzethonium chloride ointment, or thermotherapy.
Goal not met: Complete reepithelialization (healing) of the cutaneous lesion was not achieved.
Next Step — Systemic Approach
When local treatment fails, the protocol escalates to systemic therapy. More than one systemic agent class is defined, and eligibility for one of the options depends on the geographic region where infection was acquired. The full structured regimen — including which agent to use and under what conditions — is available via the link below.
Treatment goal: Complete reepithelialization (healing) of the cutaneous lesion
References
DOI: 10.1111/jtm.12089
- Treatment of L. braziliensis, Leishmania peruviana
- L. braziliensis and L. peruviana species are genetically very similar.
- 1. Pentavalent antimonials (Sb 20 mg/kg for 20 days) [A]
- 2. Liposomal amphotericin B (18 mg/kg total dose: 3 mg/kg/day, days 1 to 5 and at day 10) [B]
- 3. Miltefosine (only Bolivia, Brazil) (50 mg tid × 28 days) [C]
- Treatment failure is present when reepithelialization is incomplete 3 months after starting therapy.
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