What to Do When Wound Care Does Not Heal Cutaneous Leishmaniasis Caused by L. tropica, L. infantum/donovani, or L. aethiopica
This protocol applies to patients with cutaneous leishmaniasis due to Leishmania tropica, Leishmania infantum/donovani, or Leishmania aethiopica in whom an initial conservative approach has not produced the expected result.
Clinical Scenario
Species-specific infection caused by Leishmania tropica, Leishmania infantum/donovani, or Leishmania aethiopica — the causative organism determines the applicable treatment pathway.
Previous Treatment — Reason for Escalation
Simple wound care was used as the initial approach for limited, non-disfiguring lesions in non-immunosuppressed patients. Escalation to this protocol is triggered when complete reepithelialization (healing) of the cutaneous lesion was not achieved with that approach.
Next Step — Treatment Direction
When wound care has not led to full lesion healing, the protocol moves to active local interventions. Evidence-graded local therapy options are available for lesions that meet defined size criteria — the specific options, their selection, and how they are applied are set out in the full protocol.
Treatment goal: Complete reepithelialization of the cutaneous lesion.
References
DOI: 10.1111/jtm.12089
Condition: Treatment of L. tropica, Leishmania infantum/donovani, and Leishmania aethiopica
Treatment evidence:
- 1. Local infiltration with antimonials with or without cryotherapy [A]
- 2. 15% Paromomycin/12% methylbenzethonium chloride ointment bid for 10 to 20 days [D]
- 3. Local heat therapy (50°C for 30 seconds) [A]
Treatment failure definition: Treatment failure is present when reepithelialization is incomplete 3 months after starting therapy.
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