Cutaneous leishmaniasis treatment.
The causative species of cutaneous leishmaniasis determines the clinical features and courses, and treatments. Intralesional or systemic antimonials are the gold standard for the treatment of these diseases. However, as for visceral leishmaniasis, other therapeutic options appear promising. Paromomycin ointments are effective in Leishmania major, L. tropica, L. mexicana, and L. panamensis lesions. In L. braziliensis localized leishmaniasis, both paromomycin and imiquimod may be topically applied. Oral fluconazole and zinc sulfate are useful in L. major. Oral azithromycin, effective in vitro and in mice, needs further investigation in human leishmaniasis. On the contrary, data with oral itraconazole are disappointing. Oral miltefosine, which is very effective in visceral leishmaniasis caused by L. donovani, appears ineffective in L. major and L. braziliensis infections. Intramuscular pentamidine is required for L. guyanensis cutaneous leishmaniasis, for which systemic antimony is not effective. Liposomal amphotericin B could be an alternative to antimony in south American cutaneous leishmaniasis with mucosal involvement (especially L. braziliensis and L. guyanensis infections).
Minodier
Philippe
P
Pediatric Emergency Unit, CHU Nord, Chemin des Bourrelly, 13915 Marseille Cedex 20, France. philippe.minodier@ap-hm.fr
Parola
Philippe
P
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000634:Aminoquinolines / Q000008:administration & dosage / Q000627:therapeutic use; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use; D000818:Animals; D000965:Antimony / Q000008:administration & dosage / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D000077271:Imiquimod; D015552:Injections, Intralesional; D007273:Injections, Intramuscular; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy* / Q000469:parasitology; D010303:Paromomycin / Q000008:administration & dosage / Q000627:therapeutic use; D010419:Pentamidine / Q000008:administration & dosage / Q000627:therapeutic use; D010767:Phosphorylcholine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use
D000634:Aminoquinolines; D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D010767:Phosphorylcholine; C039128:miltefosine; D010303:Paromomycin; D010419:Pentamidine; D000666:Amphotericin B; D000965:Antimony; D000077271:Imiquimod