A Therapeutic update on Cutaneous leishmaniasis

Abstract

Leishmaniasis, in its visceral (VL), cutaneous (CL) and mucocutaneous (MCL) forms, directly affects hundreds of thousands people per annum, with millions of individuals at risk worldwide. Cutaneous leishmaniasis (CL) is an infective skin disease that manifests as ulcerated nodules, upto several centimeters in size, which are quite resistant to treatment. A wide variety of therapeutic modalities have been employed for cutaneous leishmaniasis. However, none has been demonstrated to be good enough as the first-line therapeutic agent to treat patients in all the epidemiological scenarios. Although pentavalent antimonials are widely used in the treatment of all forms of leishmaniasis, the response is far from satisfactory. These must be administered parenterally with occurrence of therapeutic failures. Secondary treatments incorporate amphotericin B, which is highly active but its use is limited by extensive toxicity complications and high cost. Several oral drugs, such as pentamidine, ketoconazole and itraconazole, have also been tested. Results obtained are not entirely satisfactory. The majority of topical agents have been tested in non-controlled studies, with only few subjects. The interpretation of results is usually difficult due to the lack of a standard and well-accepted cure definition. There remains a pressing need for new anti-leishmanials. This review is focused upon the current status of chemotherapy, the various avenues being investigated by researchers and their potential application in the future.