Situation 1 |
Situation 2 |
Situation 3 |
---|---|---|
The patient: |
All features defining situation 1 but: |
The patient: |
1) Has lesions that are all limited in size (papule, nodule or ulcerated nodule less than 4 cm), |
1) Did not cure despite previous care (as in situation 1) |
1) Had all features defining situation 1 or 2 but did not cure despite previous care |
AND |
OR |
OR |
2) Has less than four lesions |
2) Has less than four lesions for which he asks for treatment |
2) Has a lesion of 4 cm or more (plaque) |
AND |
AND |
OR |
3) Has lesions that are not potentially disfiguring or disabling (not on face, fingers or toes). |
3) Has lesion(s) located in sites compatible with local treatment |
3) Has four or more lesions requiring immediate therapy |
AND |
AND |
OR |
4) Is infected with L. major (or the lesion is already self-curing) |
4) Has one or more active lesion due to L. tropica or L. infantum |
4) Has lesion(s) located in sites NOT compatible with local treatment |
AND |
AND |
OR |
5) Is not immunocompromised and does not suffer unbalanced diabetes. |
5) Is not immunocompromised and does not suffer unbalanced diabetes. |
5) Is immunocompromised or suffers unbalanced diabetes. |
Treatment: Situation 1 |
Treatment: situation 2 |
Treatment: situation 3 |
---|---|---|
Wash lesions, and put dressing on lesion. |
Wash lesions, and put dressing on lesion. |
Wash lesions, and put dressing on lesion. |
No specific antileishmanial therapy. |
Use intralesional antimonials alone: 1-5 ml twice weekly for 3-4 weeks until complete cure. |
Systemic treatment with pentavalent antimonials: 20mg Sb5+/kg/day x 21 days |
Follow-up at 14, 30, 45 days with a final visit at 180 days. |
Follow-up at 14, 30, 45 days with a final visit at 180 days. |
Follow-up at 14, 30, 45 days with a final visit at 180 days. |
Mention the possibility for the patient to come back to receive specific antileishmanial therapy if the evolution is not satisfactory. |
Note: For more details and additional treatment options see Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region