Treatment of Cutaneous Leishmaniasis in Patients on Immunosuppressive Therapy or with HIV
Managing cutaneous leishmaniasis becomes more complex when the patient is simultaneously receiving immunosuppressive treatment or is living with HIV. This protocol addresses that specific clinical scenario and the particular considerations it requires.
Clinical Scenario
This protocol applies to patients diagnosed with cutaneous leishmaniasis who are concurrently receiving immunosuppressive treatment — including TNF-alpha antagonists, methotrexate, or prednisone — or who are HIV-positive. In most patients on these agents, the clinical presentation of cutaneous leishmaniasis is similar to that seen in immunocompetent individuals, though some differences may occur. HIV-positive patients should also be carefully assessed for coexisting visceral involvement.
Treatment Approach
Antileishmanial treatment is indicated, and lesions in this population generally respond well. Management of the underlying immunosuppressive regimen is also a key part of the approach — but the specifics of sequencing and monitoring are detailed in the full protocol.
Treatment Goal
The primary therapeutic target is complete reepithelialization — full healing — of the cutaneous lesion.
References
DOI: 10.1111/jtm.12089
- In most patients treated with a TNF-α antagonist, methotrexate or prednisone, the clinical presentation is similar to that of healthy persons; however, there might be some differences.
- HIV-positive patients with CL should be carefully assessed for coexisting VL.
- The lesions usually respond well to antileishmanial treatment.
- If possible, immunosuppressive treatment should be discontinued until after the skin lesion has healed and then restarted under close observation.
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