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Response Assessment
40. Response to treatment is assessed by clinical criteria. Repeat
parasitologic testing is not recommended if the skin lesion appears
to be healing (S-L).
Remark: The healing process may continue after the treatment course is completed
especially for large ulcerative lesions.
41. Persons with CL should have their skin lesions monitored for 6–12
months after treatment for clinical evidence of therapeutic failure,
which is initially seen at the border of a healed lesion (S-L).
Remark: The first sign of healing is usually flattening of the skin lesion. By 4–6 weeks
after treatment, the lesion size should have decreased by >50%, ulcerative lesions
should be reepithelializing, and no new lesions should be appearing. Ulcerative lesions
are generally fully reepithelialized and clinically healed by approximately 3 months
after treatment.
Treatment Failure
42. Additional therapy is recommended (but not necessarily always with
a different agent or approach) when there is development of new skin
lesions or incomplete healing by 3 months after completion of the
treatment course (S-L).
The Panel recommends that therapeutic failure be assessed by physical appearance.
Relatively little improvement or worsening while on therapy suggests an inadequate
response and an alternate treatment approach should be planned (S-L). Remark: A
paradoxical increase in the local inflammatory response may be seen in the first 2–3
weeks of treatment and can be difficult to differentiate from therapeutic failure.
43. Consultation with a leishmaniasis expert about other treatment
options is recommended for management of persons' lesions
associated with therapeutic failure (S-VL).
