Overview topical treatment of cutaneous leishmaniasis

• physical methods: cryotherapy (liquid nitrogen) for 15-20", repeated 2-3 times. Blistering will occur.

• application of local heat (e.g. infrared lamp). Heat-induced skin bullae are common.

• ointment with 15% paromomycin and 12% methylbenzethonium chloride in soft white paraffin (e.g. Leishcutan® ointment). Urea can be added as a keratolytic. Twice daily application is advised, for a duration of 20-30 days.

• skin infiltration with pentavalent antimony with a fine gauge needle. Blanching of the lesions should be obtained. Treatment is repeated every 5-7 days, in general 2-5 times, sometimes more.

• imiquimod crème (Aldara®). This immunomodulator activates macrophage killing of Leishmania amastigotes, but is best used in combination with systemic meglumine antimonate. Experience with this drug is limited. Local application of imiquimod crème (250 mg, 5% weight/volume), i.e. one individual packet every other day x 20 days is possible.

Category: Medicine Notes