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Cutaneous leishmaniasis: Treatment

Naomi Aronson, MD
Section Editor
Peter F Weller, MD, MACP
Deputy Editor
Elinor L Baron, MD, DTMH


Leishmaniasis consists of a complex of vector-borne diseases caused by a heterogeneous group of protozoa belonging to the genus Leishmania; it is transmitted by sand fly vectors [1]. There is a broad array of clinical leishmaniasis syndromes; among these, the clinical course, treatment options, response to therapy, and prognosis are all highly variable. Treatment choices are complicated by the paucity of well-controlled comparative trials and lack of standardized outcome measures [2,3].

Old World cutaneous leishmaniasis (CL) consists mainly of L.L. major and L.L. tropica. Less common species include L.L. infantum-chagasi and L.L. aethiopica (table 1). New World CL consists mainly of L.L. mexicana, L.L. amazonensis, and Viannia subgenus (table 1). Of these species, infection due to L.V. braziliensis and L.V. guyanensis are considered complicated due to risk for mucosal leishmaniasis (ML), although other species can cause mucosal leishmaniasis as well. (See "Cutaneous leishmaniasis: Clinical manifestations and diagnosis".)

The treatment of CL and ML is reviewed here. The clinical features, diagnosis, epidemiology, and control are discussed separately. (See "Cutaneous leishmaniasis: Clinical manifestations and diagnosis" and "Cutaneous leishmaniasis: Epidemiology and control".)


Clinical approach

Uncomplicated versus complicated infection — The approach to management of cutaneous leishmaniasis (CL) begins with establishing the clinical severity of infection.

Features of uncomplicated CL include [1]:

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Literature review current through: Dec 2017. | This topic last updated: Jun 29, 2017.
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  1. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH) (2016). http://cid.oxfordjournals.org/content/early/2016/11/03/cid.ciw670.full.pdf+html (Accessed on November 16, 2016).
  2. González U, Pinart M, Rengifo-Pardo M, et al. Interventions for American cutaneous and mucocutaneous leishmaniasis. Cochrane Database Syst Rev 2009; :CD004834.
  3. González U, Pinart M, Reveiz L, Alvar J. Interventions for Old World cutaneous leishmaniasis. Cochrane Database Syst Rev 2008; :CD005067.
  4. WHO Technical Report Series 949. “Control of the Leishmaniases.” 2010. http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf (Accessed on October 25, 2012).
  5. Mendonça MG, de Brito ME, Rodrigues EH, et al. Persistence of leishmania parasites in scars after clinical cure of American cutaneous leishmaniasis: is there a sterile cure? J Infect Dis 2004; 189:1018.
  6. Unger A, O'Neal S, Machado PR, et al. Association of treatment of American cutaneous leishmaniasis prior to ulcer development with high rate of failure in northeastern Brazil. Am J Trop Med Hyg 2009; 80:574.
  7. Navin TR, Arana BA, Arana FE, et al. Placebo-controlled clinical trial of sodium stibogluconate (Pentostam) versus ketoconazole for treating cutaneous leishmaniasis in Guatemala. J Infect Dis 1992; 165:528.
  8. Weigel MM, Armijos RX, Racines RJ, et al. Cutaneous leishmaniasis in subtropical Ecuador: popular perceptions, knowledge, and treatment. Bull Pan Am Health Organ 1994; 28:142.
  9. Yanik M, Gurel MS, Simsek Z, Kati M. The psychological impact of cutaneous leishmaniasis. Clin Exp Dermatol 2004; 29:464.
  10. Marsden PD. Mucosal leishmaniasis ("espundia" Escomel, 1911). Trans R Soc Trop Med Hyg 1986; 80:859.
  11. Ives A, Ronet C, Prevel F, et al. Leishmania RNA virus controls the severity of mucocutaneous leishmaniasis. Science 2011; 331:775.
  12. Zangger H, Ronet C, Desponds C, et al. Detection of Leishmania RNA virus in Leishmania parasites. PLoS Negl Trop Dis 2013; 7:e2006.
  13. Hartley MA, Ronet C, Zangger H, et al. Leishmania RNA virus: when the host pays the toll. Front Cell Infect Microbiol 2012; 2:99.
  14. Adaui V, Lye LF, Akopyants NS, et al. Association of the Endobiont Double-Stranded RNA Virus LRV1 With Treatment Failure for Human Leishmaniasis Caused by Leishmania braziliensis in Peru and Bolivia. J Infect Dis 2016; 213:112.
  15. Lawn SD, Whetham J, Chiodini PL, et al. New world mucosal and cutaneous leishmaniasis: an emerging health problem among British travellers. QJM 2004; 97:781.
  16. Blum J, Lockwood DN, Visser L, et al. Local or systemic treatment for New World cutaneous leishmaniasis? Re-evaluating the evidence for the risk of mucosal leishmaniasis. Int Health 2012; 4:153.
  17. Hodiamont CJ, Kager PA, Bart A, et al. Species-directed therapy for leishmaniasis in returning travellers: a comprehensive guide. PLoS Negl Trop Dis 2014; 8:e2832.
  18. Morizot G, Kendjo E, Mouri O, et al. Travelers with cutaneous leishmaniasis cured without systemic therapy. Clin Infect Dis 2013; 57:370.
  19. Oliveira-Neto MP, Schubach A, Mattos M, et al. A low-dose antimony treatment in 159 patients with American cutaneous leishmaniasis: extensive follow-up studies (up to 10 years). Am J Trop Med Hyg 1997; 57:651.
  20. Soto J, Rojas E, Guzman M, et al. Intralesional antimony for single lesions of bolivian cutaneous leishmaniasis. Clin Infect Dis 2013; 56:1255.
  21. Shani-Adir A, Kamil S, Rozenman D, et al. Leishmania tropica in northern Israel: a clinical overview of an emerging focus. J Am Acad Dermatol 2005; 53:810.
  22. Solomon M, Baum S, Barzilai A, et al. Liposomal amphotericin B in comparison to sodium stibogluconate for cutaneous infection due to Leishmania braziliensis. J Am Acad Dermatol 2007; 56:612.
  23. Solomon M, Pavlotzky F, Barzilai A, Schwartz E. Liposomal amphotericin B in comparison to sodium stibogluconate for Leishmania braziliensis cutaneous leishmaniasis in travelers. J Am Acad Dermatol 2013; 68:284.
  24. Machado PR, Rosa ME, Guimarães LH, et al. Treatment of Disseminated Leishmaniasis With Liposomal Amphotericin B. Clin Infect Dis 2015; 61:945.
  25. Uzun S, Durdu M, Culha G, et al. Clinical features, epidemiology, and efficacy and safety of intralesional antimony treatment of cutaneous leishmaniasis: recent experience in Turkey. J Parasitol 2004; 90:853.
  26. Asilian A, Sadeghinia A, Faghihi G, Momeni A. Comparative study of the efficacy of combined cryotherapy and intralesional meglumine antimoniate (Glucantime) vs. cryotherapy and intralesional meglumine antimoniate (Glucantime) alone for the treatment of cutaneous leishmaniasis. Int J Dermatol 2004; 43:281.
  27. Salmanpour R, Razmavar MR, Abtahi N. Comparison of intralesional meglumine antimoniate, cryotherapy and their combination in the treatment of cutaneous leishmaniasis. Int J Dermatol 2006; 45:1115.
  28. Layegh P, Pezeshkpoor F, Soruri AH, et al. Efficacy of cryotherapy versus intralesional meglumine antimoniate (glucantime) for treatment of cutaneous leishmaniasis in children. Am J Trop Med Hyg 2009; 80:172.
  29. al-Majali O, Routh HB, Abuloham O, et al. A 2-year study of liquid nitrogen therapy in cutaneous leishmaniasis. Int J Dermatol 1997; 36:460.
  30. Berman JD, Neva FA. Effect of temperature on multiplication of Leishmania amastigotes within human monocyte-derived macrophages in vitro. Am J Trop Med Hyg 1981; 30:318.
  31. Sadeghian G, Nilfroushzadeh MA, Iraji F. Efficacy of local heat therapy by radiofrequency in the treatment of cutaneous leishmaniasis, compared with intralesional injection of meglumine antimoniate. Clin Exp Dermatol 2007; 32:371.
  32. López L, Robayo M, Vargas M, Vélez ID. Thermotherapy. An alternative for the treatment of American cutaneous leishmaniasis. Trials 2012; 13:58.
  33. Aronson NE, Wortmann GW, Byrne WR, et al. A randomized controlled trial of local heat therapy versus intravenous sodium stibogluconate for the treatment of cutaneous Leishmania major infection. PLoS Negl Trop Dis 2010; 4:e628.
  34. Reithinger R, Mohsen M, Wahid M, et al. Efficacy of thermotherapy to treat cutaneous leishmaniasis caused by Leishmania tropica in Kabul, Afghanistan: a randomized, controlled trial. Clin Infect Dis 2005; 40:1148.
  35. Solomon M, Baum S, Barzilai A, et al. Treatment of cutaneous leishmaniasis with intralesional sodium stibogluconate. J Eur Acad Dermatol Venereol 2009; 23:1189.
  36. Sharquie KE, Al-Talib KK, Chu AC. Intralesional therapy of cutaneous leishmaniasis with sodium stibogluconate antimony. Br J Dermatol 1988; 119:53.
  37. Tallab TM, Bahamdam KA, Mirdad S, et al. Cutaneous leishmaniasis: schedules for intralesional treatment with sodium stibogluconate. Int J Dermatol 1996; 35:594.
  38. Kim DH, Chung HJ, Bleys J, Ghohestani RF. Is paromomycin an effective and safe treatment against cutaneous leishmaniasis? A meta-analysis of 14 randomized controlled trials. PLoS Negl Trop Dis 2009; 3:e381.
  39. El-On J, Livshin R, Even-Paz Z, et al. Topical treatment of cutaneous leishmaniasis. J Invest Dermatol 1986; 87:284.
  40. Ben Salah A, Zakraoui H, Zaatour A, et al. A randomized, placebo-controlled trial in Tunisia treating cutaneous leishmaniasis with paromomycin ointment. Am J Trop Med Hyg 1995; 53:162.
  41. Asilian A, Jalayer T, Whitworth JA, et al. A randomized, placebo-controlled trial of a two-week regimen of aminosidine (paromomycin) ointment for treatment of cutaneous leishmaniasis in Iran. Am J Trop Med Hyg 1995; 53:648.
  42. Soto JM, Toledo JT, Gutierrez P, et al. Treatment of cutaneous leishmaniasis with a topical antileishmanial drug (WR279396): phase 2 pilot study. Am J Trop Med Hyg 2002; 66:147.
  43. Ben Salah A, Buffet PA, Morizot G, et al. WR279,396, a third generation aminoglycoside ointment for the treatment of Leishmania major cutaneous leishmaniasis: a phase 2, randomized, double blind, placebo controlled study. PLoS Negl Trop Dis 2009; 3:e432.
  44. Ben Salah A, Ben Messaoud N, Guedri E, et al. Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med 2013; 368:524.
  45. Asilian A, Davami M. Comparison between the efficacy of photodynamic therapy and topical paromomycin in the treatment of Old World cutaneous leishmaniasis: a placebo-controlled, randomized clinical trial. Clin Exp Dermatol 2006; 31:634.
  46. Beach DH, Goad LJ, Holz GG Jr. Effects of antimycotic azoles on growth and sterol biosynthesis of Leishmania promastigotes. Mol Biochem Parasitol 1988; 31:149.
  47. Salmanpour R, Handjani F, Nouhpisheh MK. Comparative study of the efficacy of oral ketoconazole with intra-lesional meglumine antimoniate (Glucantime) for the treatment of cutaneous leishmaniasis. J Dermatolog Treat 2001; 12:159.
  48. Saenz RE, Paz H, Berman JD. Efficacy of ketoconazole against Leishmania braziliensis panamensis cutaneous leishmaniasis. Am J Med 1990; 89:147.
  49. Alrajhi AA, Ibrahim EA, De Vol EB, et al. Fluconazole for the treatment of cutaneous leishmaniasis caused by Leishmania major. N Engl J Med 2002; 346:891.
  50. Morizot G, Delgiudice P, Caumes E, et al. Healing of Old World cutaneous leishmaniasis in travelers treated with fluconazole: drug effect or spontaneous evolution? Am J Trop Med Hyg 2007; 76:48.
  51. Emad M, Hayati F, Fallahzadeh MK, Namazi MR. Superior efficacy of oral fluconazole 400 mg daily versus oral fluconazole 200 mg daily in the treatment of cutaneous leishmania major infection: a randomized clinical trial. J Am Acad Dermatol 2011; 64:606.
  52. Prates FV, Dourado ME, Silva SC, et al. Fluconazole in the Treatment of Cutaneous Leishmaniasis Caused by Leishmania braziliensis: A Randomized Controlled Trial. Clin Infect Dis 2017; 64:67.
  53. Paniz Mondolfi AE, Stavropoulos C, Gelanew T, et al. Successful treatment of Old World cutaneous leishmaniasis caused by Leishmania infantum with posaconazole. Antimicrob Agents Chemother 2011; 55:1774.
  54. Monge-Maillo B, López-Vélez R. Miltefosine for visceral and cutaneous leishmaniasis: drug characteristics and evidence-based treatment recommendations. Clin Infect Dis 2015; 60:1398.
  55. Ruiter GA, Zerp SF, Bartelink H, et al. Anti-cancer alkyl-lysophospholipids inhibit the phosphatidylinositol 3-kinase-Akt/PKB survival pathway. Anticancer Drugs 2003; 14:167.
  56. Soto J, Arana BA, Toledo J, et al. Miltefosine for new world cutaneous leishmaniasis. Clin Infect Dis 2004; 38:1266.
  57. Rubiano LC, Miranda MC, Muvdi Arenas S, et al. Noninferiority of miltefosine versus meglumine antimoniate for cutaneous leishmaniasis in children. J Infect Dis 2012; 205:684.
  58. Vélez I, López L, Sánchez X, et al. Efficacy of miltefosine for the treatment of American cutaneous leishmaniasis. Am J Trop Med Hyg 2010; 83:351.
  59. Chrusciak-Talhari A, Dietze R, Chrusciak Talhari C, et al. Randomized controlled clinical trial to access efficacy and safety of miltefosine in the treatment of cutaneous leishmaniasis Caused by Leishmania (Viannia) guyanensis in Manaus, Brazil. Am J Trop Med Hyg 2011; 84:255.
  60. Soto J, Rea J, Balderrama M, et al. Efficacy of miltefosine for Bolivian cutaneous leishmaniasis. Am J Trop Med Hyg 2008; 78:210.
  61. Machado PR, Ampuero J, Guimarães LH, et al. Miltefosine in the treatment of cutaneous leishmaniasis caused by Leishmania braziliensis in Brazil: a randomized and controlled trial. PLoS Negl Trop Dis 2010; 4:e912.
  62. Mohebali M, Fotouhi A, Hooshmand B, et al. Comparison of miltefosine and meglumine antimoniate for the treatment of zoonotic cutaneous leishmaniasis (ZCL) by a randomized clinical trial in Iran. Acta Trop 2007; 103:33.
  63. van Thiel PP, Leenstra T, Kager PA, et al. Miltefosine treatment of Leishmania major infection: an observational study involving Dutch military personnel returning from northern Afghanistan. Clin Infect Dis 2010; 50:80.
  64. Mosimann V, Blazek C, Grob H, et al. Miltefosine for Mucosal and Complicated Cutaneous Old World Leishmaniasis: A Case Series and Review of the Literature. Open Forum Infect Dis 2016; 3:ofw008.
  65. Dorlo TP, van Thiel PP, Huitema AD, et al. Pharmacokinetics of miltefosine in Old World cutaneous leishmaniasis patients. Antimicrob Agents Chemother 2008; 52:2855.
  66. Dorlo TP, van Thiel PP, Schoone GJ, et al. Dynamics of parasite clearance in cutaneous leishmaniasis patients treated with miltefosine. PLoS Negl Trop Dis 2011; 5:e1436.
  67. Dorlo TP, Balasegaram M, Beijnen JH, de Vries PJ. Miltefosine: a review of its pharmacology and therapeutic efficacy in the treatment of leishmaniasis. J Antimicrob Chemother 2012; 67:2576.
  68. Sindermann H, Engel J. Development of miltefosine as an oral treatment for leishmaniasis. Trans R Soc Trop Med Hyg 2006; 100 Suppl 1:S17.
  69. Dorlo TP, Balasegaram M, Lima MA, et al. Translational pharmacokinetic modelling and simulation for the assessment of duration of contraceptive use after treatment with miltefosine. J Antimicrob Chemother 2012; 67:1996.
  70. US Food and Drug Administration. News and Events - FDA News Release. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm389671.htm (Accessed on March 24, 2014).
  71. Moore E, O'Flaherty D, Heuvelmans H, et al. Comparison of generic and proprietary sodium stibogluconate for the treatment of visceral leishmaniasis in Kenya. Bull World Health Organ 2001; 79:388.
  72. Ritmeijer K, Veeken H, Melaku Y, et al. Ethiopian visceral leishmaniasis: generic and proprietary sodium stibogluconate are equivalent; HIV co-infected patients have a poor outcome. Trans R Soc Trop Med Hyg 2001; 95:668.
  73. Berman JD, Gallalee JV, Best JM. Sodium stibogluconate (Pentostam) inhibition of glucose catabolism via the glycolytic pathway, and fatty acid beta-oxidation in Leishmania mexicana amastigotes. Biochem Pharmacol 1987; 36:197.
  74. Pathak MK, Yi T. Sodium stibogluconate is a potent inhibitor of protein tyrosine phosphatases and augments cytokine responses in hemopoietic cell lines. J Immunol 2001; 167:3391.
  75. Soto J, Valda-Rodriquez L, Toledo J, et al. Comparison of generic to branded pentavalent antimony for treatment of new world cutaneous leishmaniasis. Am J Trop Med Hyg 2004; 71:577.
  76. Sáenz RE, Paz HM, Johnson CM, et al. [Evaluation of the effectiveness and toxicity of pentostam and glucantime in the treatment of cutaneous leishmaniasis]. Rev Med Panama 1987; 12:148.
  77. Deps PD, Viana MC, Falqueto A, Dietze R. [Comparative assessment of the efficacy and toxicity of N-methyl-glucamine and BP88 sodium stibogluconate in the treatment of localized cutaneous leishmaniasis]. Rev Soc Bras Med Trop 2000; 33:535.
  78. Saldanha AC, Romero GA, Guerra C, et al. [Comparative study between sodium stibogluconate BP 88 and meglumine antimoniate in cutaneous leishmaniasis treatment. II. Biochemical and cardiac toxicity]. Rev Soc Bras Med Trop 2000; 33:383.
  79. Velez I, Agudelo S, Hendrickx E, et al. Inefficacy of allopurinol as monotherapy for Colombian cutaneous leishmaniasis. A randomized, controlled trial. Ann Intern Med 1997; 126:232.
  80. Tuon FF, Amato VS, Graf ME, et al. Treatment of New World cutaneous leishmaniasis--a systematic review with a meta-analysis. Int J Dermatol 2008; 47:109.
  81. Khatami A, Firooz A, Gorouhi F, Dowlati Y. Treatment of acute Old World cutaneous leishmaniasis: a systematic review of the randomized controlled trials. J Am Acad Dermatol 2007; 57:335.e1.
  82. Sadeghian G, Nilforoushzadeh MA. Effect of combination therapy with systemic glucantime and pentoxifylline in the treatment of cutaneous leishmaniasis. Int J Dermatol 2006; 45:819.
  83. Cruz A, Rainey PM, Herwaldt BL, et al. Pharmacokinetics of antimony in children treated for leishmaniasis with meglumine antimoniate. J Infect Dis 2007; 195:602.
  84. Palacios R, Osorio LE, Grajalew LF, Ochoa MT. Treatment failure in children in a randomized clinical trial with 10 and 20 days of meglumine antimonate for cutaneous leishmaniasis due to Leishmania viannia species. Am J Trop Med Hyg 2001; 64:187.
  85. Aronson NE, Wortmann GW, Johnson SC, et al. Safety and efficacy of intravenous sodium stibogluconate in the treatment of leishmaniasis: recent U.S. military experience. Clin Infect Dis 1998; 27:1457.
  86. Oliveira LF, Schubach AO, Martins MM, et al. Systematic review of the adverse effects of cutaneous leishmaniasis treatment in the New World. Acta Trop 2011; 118:87.
  87. Gasser RA Jr, Magill AJ, Oster CN, et al. Pancreatitis induced by pentavalent antimonial agents during treatment of leishmaniasis. Clin Infect Dis 1994; 18:83.
  88. Lawn SD, Armstrong M, Chilton D, Whitty CJ. Electrocardiographic and biochemical adverse effects of sodium stibogluconate during treatment of cutaneous and mucosal leishmaniasis among returned travellers. Trans R Soc Trop Med Hyg 2006; 100:264.
  89. Wise ES, Armstrong MS, Watson J, Lockwood DN. Monitoring toxicity associated with parenteral sodium stibogluconate in the day-case management of returned travellers with New World cutaneous leishmaniasis [corrected]. PLoS Negl Trop Dis 2012; 6:e1688.
  90. Wortmann GW, Aronson NE, Byrd JC, et al. Herpes zoster and lymphopenia associated with sodium stibogluconate therapy for cutaneous leishmaniasis. Clin Infect Dis 1998; 27:509.
  91. McBride MO, Linney M, Davidson RN, Weber JN. Pancreatic necrosis following treatment of leishmaniasis with sodium stibogluconate. Clin Infect Dis 1995; 21:710.
  92. Mueller M, Balasegaram M, Koummuki Y, et al. A comparison of liposomal amphotericin B with sodium stibogluconate for the treatment of visceral leishmaniasis in pregnancy in Sudan. J Antimicrob Chemother 2006; 58:811.
  93. Pagliano P, Carannante N, Rossi M, et al. Visceral leishmaniasis in pregnancy: a case series and a systematic review of the literature. J Antimicrob Chemother 2005; 55:229.
  94. Ashutosh, Sundar S, Goyal N. Molecular mechanisms of antimony resistance in Leishmania. J Med Microbiol 2007; 56:143.
  95. Llanos-Cuentas A, Tulliano G, Araujo-Castillo R, et al. Clinical and parasite species risk factors for pentavalent antimonial treatment failure in cutaneous leishmaniasis in Peru. Clin Infect Dis 2008; 46:223.
  96. O'Neal SE, Guimarães LH, Machado PR, et al. Influence of helminth infections on the clinical course of and immune response to Leishmania braziliensis cutaneous leishmaniasis. J Infect Dis 2007; 195:142.
  97. Brajtburg J, Powderly WG, Kobayashi GS, Medoff G. Amphotericin B: current understanding of mechanisms of action. Antimicrob Agents Chemother 1990; 34:183.
  98. Amato VS, Tuon FF, Imamura R, et al. Mucosal leishmaniasis: description of case management approaches and analysis of risk factors for treatment failure in a cohort of 140 patients in Brazil. J Eur Acad Dermatol Venereol 2009; 23:1026.
  99. Rocio C, Amato VS, Camargo RA, et al. Liposomal formulation of amphotericin B for the treatment of mucosal leishmaniasis in HIV-negative patients. Trans R Soc Trop Med Hyg 2014; 108:176.
  100. Cunha MA, Leão AC, de Cassia Soler R, Lindoso JA. Efficacy and Safety of Liposomal Amphotericin B for the Treatment of Mucosal Leishmaniasis from the New World: A Retrospective Study. Am J Trop Med Hyg 2015; 93:1214.
  101. Yardley V, Croft SL. A comparison of the activities of three amphotericin B lipid formulations against experimental visceral and cutaneous leishmaniasis. Int J Antimicrob Agents 2000; 13:243.
  102. Wortmann GW, Fraser SL, Aronson NE, et al. Failure of amphotericin B lipid complex in the treatment of cutaneous leishmaniasis. Clin Infect Dis 1998; 26:1006.
  103. Llanos A, Cieza J, Bernardo J, et al. Effect of salt supplementation on amphotericin B nephrotoxicity. Kidney Int 1991; 40:302.
  104. Maheshwari A, Seth A, Kaur S, et al. Cumulative cardiac toxicity of sodium stibogluconate and amphotericin B in treatment of kala-azar. Pediatr Infect Dis J 2011; 30:180.
  105. Thakur CP. Sodium antimony gluconate, amphotericin, and myocardial damage. Lancet 1998; 351:1928.
  106. Wortmann G, Zapor M, Ressner R, et al. Lipsosomal amphotericin B for treatment of cutaneous leishmaniasis. Am J Trop Med Hyg 2010; 83:1028.
  107. Townsend RW, Zutshi A, Bekersky I. Biodistribution of 4-[(14)C]cholesterol-AmBisome following a single intravenous administration to rats. Drug Metab Dispos 2001; 29:681.
  108. Neves LO, Talhari AC, Gadelha EP, et al. A randomized clinical trial comparing meglumine antimoniate, pentamidine and amphotericin B for the treatment of cutaneous leishmaniasis by Leishmania guyanensis. An Bras Dermatol 2011; 86:1092.
  109. Motta JO, Sampaio RN. A pilot study comparing low-dose liposomal amphotericin B with N-methyl glucamine for the treatment of American cutaneous leishmaniasis. J Eur Acad Dermatol Venereol 2012; 26:331.
  110. Solomon M, Pavlotsky F, Leshem E, et al. Liposomal amphotericin B treatment of cutaneous leishmaniasis due to Leishmania tropica. J Eur Acad Dermatol Venereol 2011; 25:973.
  111. Goto H, Lindoso JA. Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Expert Rev Anti Infect Ther 2010; 8:419.
  112. Hellier I, Dereure O, Tournillac I, et al. Treatment of Old World cutaneous leishmaniasis by pentamidine isethionate. An open study of 11 patients. Dermatology 2000; 200:120.
  113. Jauréguiberry S, Graby G, Caumes E. Efficacy of short-course intramuscular pentamidine isethionate treatment on Old World localized cutaneous leishmaniasis in 2 patients. Clin Infect Dis 2006; 42:1812.
  114. Low-A-Chee RM, Rose P, Ridley DS. An outbreak of cutaneous leishmaniasis in Guyana: epidemiology, clinical and laboratory aspects. Ann Trop Med Parasitol 1983; 77:255.
  115. Pradinaud R, et al. Bilan de 10 annees de traitement de la leishmaniose tegumentaire par la pentamidine en Guyane Francaise: a propos de 1025 cas. Nouv Dermatol 1991; 10:456.
  116. Lightburn E, Morand JJ, Meynard JB, et al. [Management of American cutaneous leishmaniasis. Outcome apropos of 326 cases treated with high-dose pentamidine isethionate]. Med Trop (Mars) 2003; 63:35.
  117. Lai A Fat EJ, Vrede MA, Soetosenojo RM, Lai A Fat RF. Pentamidine, the drug of choice for the treatment of cutaneous leishmaniasis in Surinam. Int J Dermatol 2002; 41:796.
  118. van der Meide WF, Sabajo LO, Jensema AJ, et al. Evaluation of treatment with pentamidine for cutaneous leishmaniasis in Suriname. Int J Dermatol 2009; 48:52.
  119. Andersen EM, Cruz-Saldarriaga M, Llanos-Cuentas A, et al. Comparison of meglumine antimoniate and pentamidine for peruvian cutaneous leishmaniasis. Am J Trop Med Hyg 2005; 72:133.
  120. Soto-Mancipe J, Grogl M, Berman JD. Evaluation of pentamidine for the treatment of cutaneous leishmaniasis in Colombia. Clin Infect Dis 1993; 16:417.
  121. Soto J, Buffet P, Grogl M, Berman J. Successful treatment of Colombian cutaneous leishmaniasis with four injections of pentamidine. Am J Trop Med Hyg 1994; 50:107.
  122. Murray HW. Leishmaniasis in the United States: treatment in 2012. Am J Trop Med Hyg 2012; 86:434.
  123. Sakthianandeswaren A, Elso CM, Simpson K, et al. The wound repair response controls outcome to cutaneous leishmaniasis. Proc Natl Acad Sci U S A 2005; 102:15551.
  124. Khatami A, Talaee R, Rahshenas M, et al. Dressings combined with injection of meglumine antimoniate in the treatment of cutaneous leishmaniasis: a randomized controlled clinical trial. PLoS One 2013; 8:e66123.
  125. Wortmann GW, Aronson NE, Miller RS, et al. Cutaneous leishmaniasis following local trauma: a clinical pearl. Clin Infect Dis 2000; 31:199.
  126. Machado PR, Lessa H, Lessa M, et al. Oral pentoxifylline combined with pentavalent antimony: a randomized trial for mucosal leishmaniasis. Clin Infect Dis 2007; 44:788.
  127. Saenz RE, de Rodriguez CG, Johnson CM, Berman JD. Efficacy and toxicity of pentostam against Panamanian mucosal leishmaniasis. Am J Trop Med Hyg 1991; 44:394.
  128. Franke ED, Wignall FS, Cruz ME, et al. Efficacy and toxicity of sodium stibogluconate for mucosal leishmaniasis. Ann Intern Med 1990; 113:934.
  129. Franke ED, Llanos-Cuentas A, Echevarria J, et al. Efficacy of 28-day and 40-day regimens of sodium stibogluconate (Pentostam) in the treatment of mucosal leishmaniasis. Am J Trop Med Hyg 1994; 51:77.
  130. Amato V, Amato J, Nicodemo A, et al. [Treatment of mucocutaneous leishmaniasis with pentamidine isothionate]. Ann Dermatol Venereol 1998; 125:492.
  131. Amato VS, Tuon FF, Siqueira AM, et al. Treatment of mucosal leishmaniasis in Latin America: systematic review. Am J Trop Med Hyg 2007; 77:266.
  132. Sampaio SA, Castro RM, Dillon NL, Martins JE. Treatment of mucocutaneous (American) leishmaniasis with amphotericin B: report of 70 cases. Int J Dermatol 1971; 10:179.
  133. Rodriguez LV, Dedet JP, Paredes V, et al. A randomized trial of amphotericin B alone or in combination with itraconazole in the treatment of mucocutaneous leishmaniasis. Mem Inst Oswaldo Cruz 1995; 90:525.
  134. Amato VS, Tuon FF, Camargo RA, et al. Can we use a lower dose of liposomal amphotericin B for the treatment of mucosal American leishmaniasis? Am J Trop Med Hyg 2011; 85:818.
  135. Soto J, Toledo J, Valda L, et al. Treatment of Bolivian mucosal leishmaniasis with miltefosine. Clin Infect Dis 2007; 44:350.
  136. Soto J, Rea J, Valderrama M, et al. Efficacy of extended (six weeks) treatment with miltefosine for mucosal leishmaniasis in Bolivia. Am J Trop Med Hyg 2009; 81:387.
  137. el-Hassan AM, Meredith SE, Yagi HI, et al. Sudanese mucosal leishmaniasis: epidemiology, clinical features, diagnosis, immune responses and treatment. Trans R Soc Trop Med Hyg 1995; 89:647.
  138. Aliaga L, Cobo F, Mediavilla JD, et al. Localized mucosal leishmaniasis due to Leishmania (Leishmania) infantum: clinical and microbiologic findings in 31 patients. Medicine (Baltimore) 2003; 82:147.
  139. Jeronimo SMB, de Queiroz Sousa A, Pearson RD. Leishmaniasis. In: Tropical Infectious Diseases: Principles, Pathogens and Practice, 3rd ed, Guerrant RL, Walker DH, Weller PF (Eds), Saunders Elsevier, Philadelphia 2011. p.696.