Duration of Treatment for Cutaneous Leishmaniasis
The duration of treatment for cutaneous leishmaniasis depends on the therapeutic modality used: systemic therapy requires 20-28 days of treatment, intralesional therapy is repeated every 3-7 days until healing occurs, and physical methods (heat/cryotherapy) are repeated at 3-week intervals for 6-8 weeks until healing is achieved. 1, 2
Systemic Therapy Duration
Pentavalent Antimonials
- Administer for 20 consecutive days for cutaneous leishmaniasis at a dose of 20 mg/kg/day without an upper limit on the daily dose 3
- This represents the standard duration for cutaneous disease, which is shorter than the 28-day course required for visceral or mucosal leishmaniasis 3
Miltefosine (IMPAVIDO)
- Treatment duration is 28 consecutive days for cutaneous leishmaniasis caused by L. braziliensis, L. guyanensis, and L. panamensis 2
- Dosing is weight-based: 50 mg twice daily (30-44 kg) or 50 mg three times daily (≥45 kg), administered with food 2
- This FDA-approved regimen is fixed at 28 days regardless of clinical response during treatment 2
Local Therapy Duration
Intralesional Pentavalent Antimonials
- Repeat injections every 3-7 days until complete healing occurs 1
- The WHO recommends this interval-based approach rather than a fixed number of treatments 1
- Continue until blanching is achieved and the entire lesion plus 1-2 mm of surrounding normal skin is infiltrated 1
Physical Methods (Heat/Cryotherapy)
- Repeat treatments at 3-week intervals for 6-8 weeks until healing is documented 1
- When combining cryotherapy with intralesional antimony, administer both modalities every 1-2 weeks for 6-8 weeks 1
- The skill of the operator and complete application are critical to success 1
Monitoring Treatment Response
Expected Timeline for Healing
- By 4-6 weeks after treatment completion, lesion size should decrease by >50%, with ulcerative lesions showing re-epithelialization and no new lesions appearing 1
- Complete healing typically occurs by approximately 3 months after treatment completion for ulcerative lesions 1
- The healing process may continue after the treatment course is completed, especially for large ulcerative lesions 1
Long-Term Surveillance
- Monitor skin lesions for 6-12 months after treatment for clinical evidence of therapeutic failure, which initially appears at the border of a healed lesion 1
- The first sign of healing is usually flattening of the skin lesion 1
When to Extend or Repeat Treatment
Criteria for Additional Therapy
- Administer additional therapy if incomplete healing occurs by 3 months after completion of the treatment course 1
- Additional therapy is also indicated when new skin lesions develop or existing lesions worsen 1
- Relatively little improvement or worsening while on therapy suggests inadequate response and warrants an alternate treatment approach 1
Important Caveat
- A paradoxical increase in local inflammatory response may occur in the first 2-3 weeks of treatment, including new satellite lesions and increased erythema/induration, especially around the border 1
- This exacerbation does not indicate treatment failure and typically resolves within 3-4 weeks with adequate treatment 1
- This can be difficult to differentiate from true therapeutic failure 1
Species-Specific Considerations
Natural History Without Treatment
- L. major lesions tend to heal spontaneously within 2-6 months 1
- L. mexicana lesions heal within 3-9 months 1
- L. tropica, L. braziliensis, and L. panamensis lesions heal within 6-15 months 1
- Despite these natural healing timelines, treatment is recommended to prevent mucosal disease, reduce scarring, and accelerate healing 1