What are the recommended first-line treatments for cutaneous leishmaniasis in adults?

The recommended first-line treatments for cutaneous leishmaniasis in adults typically involve local therapies such as intralesional antimonial injections or topical paromomycin, especially for limited disease. Systemic treatment with pentavalent antimonials (e.g., sodium stibogluconate) is generally reserved for more extensive, multiple, or complicated lesions.

In the UK context, treatment decisions are often guided by the lesion's severity, location, and species of Leishmania, with local therapy preferred initially to minimise systemic toxicity. For patients with lesions unsuitable for local treatment, systemic therapy is indicated.

Recent literature from endemic regions, such as the overview by Abuzaid et al. (2017), supports these approaches and highlights the efficacy of pentavalent antimonials as first-line systemic agents, while also noting emerging alternatives like liposomal amphotericin B in resistant or intolerant cases.

Therefore, the integrated approach is to start with local treatment for uncomplicated cutaneous leishmaniasis and escalate to systemic pentavalent antimonials if necessary, considering patient factors and lesion characteristics.

This combined strategy aligns with UK clinical practice guidelines and is corroborated by international evidence from endemic areas (Abuzaid et al., 2017) ¹.