Wound Management Strategy for Treatment of Localized Cutaneous Leishmaniasis Using the TIME Framework

The current drugs available for the treatment of cutaneous leishmaniasis (CL) often cause several adverse events, and the risk-benefit ratio is low due to the risk of severe complications. Current treatment recommendations are based on data from areas endemic for leishmaniasis and are not always perfectly applicable, especially in cases of imported CL. Thus, it is crucial to assess the level of severity in each case to provide the most appropriate treatment modality. The World Health Organization recommends simple wound care (with unspecified strategies) or local therapy as first-line treatment. Systemic treatments should be reserved for selected patients. Additionally, there is little evidence in the literature regarding local treatments, such as paromomycin ointments, imiquimod, local infiltration with antimonials, and physical treatments such as cryotherapy or thermotherapy.

The authors report the use of the tissue debridement, infection/inflammation management, moisture balance, and edge assessment (TIME) model of wound bed preparation in a case of localized ulcerated CL.

A 32-year-old female developed ulcerated nodules at the sites of insect bites that occurred during a trip to Columbia and was diagnosed with localized CL. Wound management included daily wound bed cleansing, surgical debridement, and antimicrobial and secondary polyurethane foam dressings. The lesions completely healed in 30 days.

In the present case, the TIME approach simplified the local management of ulcerated CL, thereby improving both the healing process and cosmetic outcome. Further studies with a placebo-controlled group will be necessary to confirm the data.