Cutaneous Leishmaniasis Caused by Leishmania major: Active Treatment When Watchful Waiting Has Not Achieved Healing
This protocol applies to patients with cutaneous leishmaniasis caused by Leishmania major whose lesions have not healed under an initial strategy of watchful waiting and simple wound care.
Clinical Scenario
Cutaneous leishmaniasis caused by Leishmania major. The causative species shapes which treatment options apply.
Previous Line — Healing Not Achieved
The prior approach — no antileishmanial treatment, with simple wound care and watchful waiting (considered an acceptable option in non-immunosuppressed patients with non-cosmetically disfiguring lesions) — did not result in complete reepithelialization of the cutaneous lesion. Failure to achieve that goal is the trigger for escalation to this protocol.
Treatment Approach (Partial Overview)
The protocol defines locally applied treatment options for lesions meeting specified size criteria, with several distinct local modalities available.
The full regimen — including all options, eligibility criteria, sequencing, and any restrictions — is available in the complete protocol.
Treatment goal: Complete reepithelialization (healing) of the cutaneous lesion.
References
DOI: 10.1111/jtm.12089
- Treatment of L. major
- 1. "Flash" cryotherapy plus local infiltration with antimonials [A]
- 2. 15% Paromomycin or 12% methylbenzethonium chloride ointment bid for 10 to 20 days [A]
- 3. Local heat therapy (50°C for 30 seconds) [A]
- Treatment failure is present when reepithelialization is incomplete 3 months after starting therapy.
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