Blum and Hatz listed indications for systemic therapy of a travler who develops cutaneous leishmaniasis. The authors are from the Swiss Tropical Institute in Basel, Switzerland.
Indications for systemic treatment:
(1) most cases of New World cutaneous leishmaniasis
(2) chiclero ulcer (chronic ear lesion caused by L. mexicana)
(3) mucosal leishmaniasis
(4) spread to lymph nodes
(5) involvement of the nose and/or eyelids
(6) lesions close to a joint
(7) multiple lesions
(8) lesion > 5 cm in diameter
(9) failure to respond to topical therapy
For most cases of Old World cutaneous leishmaniasis topical therapy is the first-line of approach.
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