Management

A single ulcer caused by L. tropica or L. major which is not likely to be contaminated by bacteria and is cosmetically acceptable may be left to heal spontanesouly. In all other circumstances cutaneous leishmaniasis, especially diffuse and mucocutaneous disease, should be treated.

The first line drug in the treatment of leishmaniasis is the pentavalent antimony compound, sodium stibogluconate. Treatment is inconvenient because the drug must be given by daily intravenous injection for 20-30 days.

For resistant disease pentamidine or liposomal amphoteracin may be used.

Notes:

• there is evidence from a small study showing the effectiveness of topically applied granulocyte-macrophage colony-stimulating factor (GM-CSF) as an adjunct to antimonial therapy in the management of cutaneous leishmaniasis

Reference:

1. Santos JB et al. Antimony plus recombinant human granulocyte-macrophage colony-stimulating factor applied topically in low doses enhances healing of cutaneous leishmaniasis ulcers: a randomized, double-blind, placebo-controlled study. J Infect Dis 2004;190:1793-6.