What alternative agents and therapeutic modalities are used in the treatment of cutaneous leishmaniasis?

Updated: Feb 18, 2020
  • Author: Craig G Stark, MD, FACP, FFTM, RCPS(Glasg), FISTM; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

A short course of intramuscular pentamidine for 4 days was reported to be effective for cutaneous disease in Colombia. [50] A single report from Tunisia found doxycycline to be effective in cutaneous leishmaniasis. [51]

Other reported treatments include topical imiquimod cream, cryotherapy, thermotherapy, ketoconazole, photodynamic therapy, itraconazole, and allopurinol. However, these are effective only when used in combination with the first-line drugs

Because Leishmania species are temperature-sensitive, local treatment with heat or cold provides an alternative to pharmaceutical therapy in some cases. Cryotherapy can be used on small, uncomplicated Old World lesions. A 15- to 20-second freeze-thaw-refreeze cycle repeated as needed over 1-2 weeks was sufficient to cure most cases of uncomplicated L tropica and L major infections.

In 2003, the FDA approved the ThermoMed device for the treatment of cutaneous leishmaniasis. This device heats the skin through radiofrequency waves directed to a specified area and depth. A study conducted in Afghanistan involving cutaneous disease caused by L tropica demonstrated a cure rate of 69% at 100 days after treatment. [52] However, the lesions treated in this study were small. Further studies may demonstrate this to be a useful therapy for mild disease.


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