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Cutaneous leishmaniasis: Treatment

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

INTRODUCTION

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. 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 [1,2].

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".)

CUTANEOUS LEISHMANIASIS

Clinical approach — Many cutaneous leishmaniasis (CL) infections eventually resolve clinically without treatment, and not all patients who undergo treatment demonstrate elimination of parasitic infection [3]. The benefits of treatment include accelerated healing of skin lesions [4,5], reduced likelihood of recurrence (especially in the setting of subsequent immune compromise), diminished severity of skin scarring and attendant emotional concerns [6,7], and reduced risk for metastatic infection (which is important for individuals with immune compromise and/or for individuals with infection due to Viannia subgenus) [8]. In addition, in the setting of infection due to the anthroponotic species L.L. tropica, treatment may reduce the reservoir for transmission.

The objective of CL treatment is clinical cure, not parasitologic cure. Treatment decisions must include consideration of individual risks and benefits, which can be complex given the large number of parasite species with variable clinical syndromes, complications, and rates of spontaneous resolution. (See "Cutaneous leishmaniasis: Clinical manifestations and diagnosis".)

                         

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