What to Do When Local Treatment for L. mexicana Cutaneous Leishmaniasis Has Not Worked

Clinical Scenario

This protocol addresses cutaneous leishmaniasis caused by Leishmania mexicana in patients who have more than three lesions with a diameter exceeding 30 mm, lesions in a delicate anatomical location, or disease that has not responded to topical (local) treatment.

Prior Treatment — Goal Not Reached

The preceding treatment step used local approaches — cryotherapy with antimonial infiltration, or paromomycin- or methylbenzethonium chloride-based ointment — for patients with fewer or smaller lesions. When that local treatment does not achieve complete reepithelialization (full healing) of the cutaneous lesion, this systemic protocol is the indicated next step.

Treatment Approach (Partial)

This protocol moves to systemic pharmacological treatment. The evidence-based regimen describes several agent options — the complete selection, sequencing, and all dosing details are available in the full protocol.

Clinical Goal

Complete reepithelialization — full healing — of the cutaneous lesion.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/jtm.12089

Treatment of L. mexicana

More than three lesions with diameter >30 mm, delicate location and/or refractory to topical treatment — systemic treatment:

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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