Cutaneous Leishmaniasis Caused by L. mexicana: When Local Treatment Has Not Achieved Healing
Clinical Scenario
This protocol applies to patients with cutaneous leishmaniasis caused by Leishmania mexicana whose initial course of local therapy did not achieve complete reepithelialization of the cutaneous lesion.
Previous Treatment — Failure Condition
First-line local treatment — cryotherapy, local infiltration with antimonials, or topical paromomycin/methylbenzethonium chloride ointment — was administered but did not meet its target: complete reepithelialization (healing) of the cutaneous lesion. Non-achievement of this goal is the trigger for escalation to systemic therapy.
Next Step: Systemic Treatment
Systemic treatment is indicated when lesions are extensive, involve a sensitive anatomical location, or are refractory to local measures. Several systemic options exist — the structured regimen, including agent selection criteria, is detailed in the full protocol.
Dosing, sequencing, and monitoring parameters are not shown here.
References
DOI: 10.1111/jtm.12089
- Treatment of L. mexicana
- 1. Ketoconazole (600 mg/day × 28 days) [B]
- 2. Miltefosine (50 mg tid × 28 days) [B]
- 3. Pentavalent antimonials (Sb 20 mg/kg for 20 days) [D]
- Treatment failure is present when reepithelialization is incomplete 3 months after starting therapy.
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