10
Treatment
Cutaneous Leishmaniasis (CL)
Treatment recommendations for CL are not straightforward; many CL infections may
clinically resolve without treatment.
For CL, the interrelated goals of treatment include minimizing local tissue damage
and cosmetic or functional consequences, accelerating the rate of healing, reducing the
likelihood of local recurrences, and decreasing the risk of developing mucosal disease
caused by parasites in the Viannia subgenus. The therapeutic strateg y depends in
part on the infecting species or, as a proxy, whether the infection was acquired in the
Americas (New World cutaneous leishmaniasis; NWCL) or elsewhere (Old World
cutaneous leishmaniasis; OWCL).
Local therapy may be an option for some cases of CL, and use of systemic therapy may
be indicated or prudent for others.
23. After a careful diagnostic evaluation in which neither leishmaniasis nor
another diagnosis is confirmed, empiric treatment may be indicated on
the basis of an individualized risk-benefit assessment (W-VL).
Remark: This should be discussed with the patient and reevaluated periodically,
taking into account the clinical evolution.
24. The Panel recommends that immunocompetent persons with
skin lesions that are caused by infection with Leishmania species
that are not associated with increased risk for ML, that are
defined as clinically simple lesions (Table 1), and that are healing
spontaneously may be observed without treatment if the patient
concurs with this management (S-M).
25. For persons with CL when the Leishmania species is not known but
the infection was not acquired in an increased ML-risk region (Table
1, Figure 2), treatment of clinically simple or healing skin lesions is
not required in an immunocompetent patient who concurs with this
management (S-L; E.C. dissents, recommending that all persons with
NWCL receive treatment).
Remark: See Recs. 67–69 and Recs. 70–77 regarding the management of CL in
immunocompromised persons.
26. The Panel suggests that systemic treatment be offered for persons
even with healing/recently healed CL lesions caused by increased
ML-risk species or when the species is unknown but the infection
was acquired in an increased ML-risk region. Risks and benefits of
such treatment should be discussed with the patient (W-L).
Remark: In some cases, watchful waiting, with vigilance for signs and symptoms of
ML, may be a reasonable approach.
