Managing cutaneous leishmaniasis during pregnancy requires particular caution. This protocol addresses the situation where preferred local and physical measures have not resulted in complete healing of the lesion, and a further clinical decision is needed.
Pregnancy with cutaneous leishmaniasis is a high-constraint situation. As none of the systemic treatments are known to be safe during pregnancy, the established first approach is to withhold systemic therapy until after delivery, using topical treatment, simple wound care, or physical methods — including cryotherapy, thermotherapy, or CO2 laser — when intervention is needed before that point.
This protocol applies when cryotherapy, thermotherapy, CO2 laser, topical treatment, or wound care has not achieved complete reepithelialization (healing) of the cutaneous lesion, and the lesion's location, size, or persistence makes further management necessary during the pregnancy itself.
In the rare situation where systemic therapy cannot be deferred, one specific parenteral agent is considered to offer the most favourable benefit-to-risk profile in this setting. The full structured protocol — including the complete selection criteria, monitoring requirements, and stepwise management — is available below.
Complete reepithelialization (healing) of the cutaneous lesion. Treatment failure is considered present when reepithelialization remains incomplete 3 months after starting therapy.
DOI: 10.1111/jtm.12089