Cutaneous Leishmaniasis (L. tropica / L. infantum / L. aethiopica) — What to Do When Local Treatment Has Not Achieved Healing
Clinical Scenario
This protocol applies to cutaneous leishmaniasis caused by Leishmania tropica, Leishmania infantum/donovani, or Leishmania aethiopica in patients whose lesions have not resolved with initial local therapy.
Prior Treatment Did Not Reach the Goal
Local treatment — which may include infiltration with antimonials with or without cryotherapy, topical paromomycin/methylbenzethonium chloride ointment, or local heat therapy — was applied but failed to produce complete reepithelialization (healing) of the cutaneous lesion. This protocol is the next step after that failure.
Next-Line Treatment Approach (Partial Overview)
After local treatment failure, a systemic approach is indicated — the full protocol defines which systemic agents apply in this setting and how to choose between alternatives.
Treatment Goal
Complete reepithelialization (healing) of the cutaneous lesion.
References
DOI: 10.1111/jtm.12089
- Treatment of L. tropica, Leishmania infantum/donovani, and Leishmania aethiopica
- 1. Liposomal amphotericin B (18 mg/kg total dose: 3 mg/kg/day, days 1 to 5 and at day 10) [C]
- 2. Miltefosine (50 mg tid × 28 days) [D]
- 3. Pentavalent antimonials (Sb 20 mg/kg for 10–20 days) (+/− allopurinol) [C]
- Treatment failure is present when reepithelialization is incomplete 3 months after starting therapy.