Cutaneous Leishmaniasis Due to Leishmania major: What to Do When Watchful Waiting Has Not Achieved Complete Healing
Clinical Scenario
This protocol applies to cutaneous leishmaniasis caused by Leishmania major. It is relevant when an initial period of observation without antileishmanial treatment has not resulted in complete healing of the cutaneous lesion, and active intervention is now warranted.
Prior Approach — Insufficient
The first management step for qualifying patients was watchful waiting: simple wound care only, with no antileishmanial treatment — an approach used when lesions were not cosmetically disfiguring and the patient was not immunosuppressed. The required outcome — complete reepithelialization (healing) of the cutaneous lesion — was not achieved, making escalation necessary.
Next Step: Active Local Treatment
Once watchful waiting proves insufficient, structured local treatment for qualifying lesions is indicated. Several distinct local therapeutic modalities exist for this situation — the full protocol defines which apply and under what conditions. No dosages or sequencing are provided here.
Treatment Goal
Complete reepithelialization (healing) of the cutaneous lesion.
References
DOI: 10.1111/jtm.12089
- Treatment of L. major
- Up to three lesions with diameters <30 mm local treatment:
- ‘‘Flash’’ cryotherapy plus local infiltration with antimonials
- 15% Paromomycin or 12% methylbenzethonium chloride ointment bid for 10 to 20 days
- Local heat therapy (50°C for 30 seconds)
- Cutaneous lesions usually heal within a month after starting treatment with pentavalent antimonials, either by local infiltration [Old World cutaneous leishmaniasis (OWCL)] or given systemically [New World cutaneous leishmaniasis (NWCL)], but large ulcers may take longer.
- Treatment failure is present when reepithelialization is incomplete 3 months after starting therapy.
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