Cutaneous Leishmaniasis in Pregnancy — When Initial Conservative Management Has Not Achieved Complete Lesion Healing

This protocol addresses cutaneous leishmaniasis occurring during pregnancy when the first-line conservative approach — prioritising non-systemic measures — has not resulted in complete healing of the cutaneous lesion.

Pregnancy is the defining clinical context here. Because no systemic treatment for cutaneous leishmaniasis has been established as safe during pregnancy, the initial strategy withholds systemic therapy and relies on wound care, physical methods, or topical approaches. The clinical objective throughout is complete reepithelialization of the cutaneous lesion.

Previous Line — Did Not Achieve Complete Reepithelialization

The first-line approach — wound care, physical methods (cryotherapy, thermotherapy, or CO₂ laser), or topical therapy, with systemic treatment withheld until after delivery — did not achieve the target of complete lesion healing. This protocol describes the structured step taken after that failure.

Treatment Approach (Partial Overview)

When lesion characteristics necessitate systemic therapy during pregnancy, one specific agent is considered to offer the most favourable benefit-to-risk profile in this setting — the complete protocol details the indication criteria, agent selection, and full clinical pathway.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/jtm.12089

As none of the systemic treatments are known to be safe during pregnancy, systemic treatment should be withheld until after delivery; topical treatment may be applied before.

In rare situations when lesion location, size, impact and persistence, despite local therapy, require systemic therapy, liposomal amphotericin B probably has the best benefit : risk ratio.

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