Travelers with cutaneous leishmaniasis cured without systemic therapy.

Area of Science:

• Dermatology
• Infectious Diseases
• Parasitology

Background:

• Cutaneous leishmaniasis (CL) is a disfiguring skin disease.
• Antileishmanial drugs carry potential toxicity risks.
• WHO guidelines recommend stepwise treatment, prioritizing local care.

Purpose of the Study:

• To assess the feasibility and impact of the WHO's recommended stepwise treatment approach for CL.
• To evaluate the effectiveness of initial non-systemic therapies for CL patients.
• To analyze cure rates and adverse events associated with different CL treatment strategies.

Main Methods:

• Analysis of treatment outcomes in 135 patients with confirmed CL.
• Categorization of patients based on initial treatment: no systemic therapy, local therapy, or systemic therapy.
• Evaluation of cure rates at days 42-60 and systemic adverse events.

Main Results:

• 62% of patients initially received treatment without systemic therapy.
• High cure rates were observed with simple wound care (92%) and local antileishmanial therapy (79%).
• Systemic therapy achieved a 60% cure rate in complex cases, with adverse events in 15 patients.

Conclusions:

• The WHO stepwise approach effectively managed CL in many patients without systemic drugs.
• Approximately 44% of all patients were cured without systemic therapy, avoiding associated risks.
• Further simplification of local CL therapies and improved management for complex cases are needed.