14
Treatment
Table 1. Clinical Characteristics of Cutaneous
Leishmaniasis (CL) that May Modify Management
in North America
"Simple" CL "Complex" CL
Caused by a Leishmania species
unlikely to be associated with mucosal
leishmaniasis (ML)
Caused by a Leishmania species that can
be associated with increased risk for ML,
particularly Viannia spp. in the "mucosal
belt" of Bolivia, Peru, and Brazil
a
No mucosal involvement noted
Local subcutaneous nodules
b
Absence of characteristics of complex CL
Large regional adenopathy
b
Only a single or a few skin lesions >4 skin lesions of substantial size
(eg, >1 cm)
Small lesion size (diameter <1 cm) Large individual skin lesion
(diameter ≥5 cm)
Location of lesion feasible for local
treatment
Size or location of lesion such that local
treatment is not feasible
Nonexposed skin
(ie, not cosmetically important)
Lesion on face, including ears, eyelids,
or lips; fingers, toes, or other joints; or
genitalia
Immunocompetent host Immunocompromised host (especially
with respect to cell-mediated immunity)
Lesion(s) resolving without prior therapy Clinical failure of local therapy
Unusual syndromes: leishmaniasis
recidivans, diffuse CL, or disseminated CL
a
e highest risk areas for mucosal leishmaniasis (ML) are south of the Amazon basin in parts of
Bolivia, Peru, and Brazil (defined here as the "mucosal belt"). Moderate-risk areas are south of
Nicaragua to the Amazon basin. Low-risk areas for ML are in NWCL (Viannia)-endemic regions
north of Costa Rica.
b
Controversial, but certainly if bubonic-like adenopathy in regional drainage area of lesions.
ese findings have been linked to complications or treatment failure when only local treatment
is administered. Some experts would not consider systemic therapy needed for a few, small
subcutaneous nodules in Old World CL.
