Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera de Colmenar Km 9,1, 28034, Madrid, Spain.
Drugs. 2013 Nov;73(17):1889-920. doi: 10.1007/s40265-013-0132-1.
Estimated worldwide incidence of tegumentary leishmaniasis (cutaneous leishmaniasis [CL] and mucocutaneous leishmaniasis [MCL]) is over 1.5 million cases per year in 82 countries, with 90 % of cases occurring in Afghanistan, Brazil, Iran, Peru, Saudi Arabia and Syria. Current treatments of CL are poorly justified and have sub-optimal effectiveness. Treatment can be based on topical or systemic regimens. These different options must be based on Leishmania species, geographic regions, and clinical presentations. In certain cases of Old World CL (OWCL), lesions can spontaneously heal without any need for therapeutic intervention. Local therapies (thermotherapy, cryotherapy, paromomycin ointment, local infiltration with antimonials) are good options with less systemic toxicity, reserving systemic treatments (azole drugs, miltefosine, antimonials, amphotericin B formulations) mainly for complex cases. The majority of New World CL (NWCL) types require systemic treatment (mainly with pentavalent antimonials), either to speed the healing or to prevent dissemination to oral-nasal mucosa as MCL (NWMCL). These types of lesions are potentially serious and always require systemic-based regimens, mainly antimonials and pentamidine; however, the associated immunotherapy is promising. This paper is an exhaustive review of the published literature on the treatment of OWCL, NWCL and NWMCL, and provides treatment recommendations stratified according to their level of evidence regarding the species of Leishmania implicated and the geographical location of the infection.
全世界估计每年有超过 150 万例皮肤利什曼病（皮肤利什曼病[CL]和黏膜皮肤利什曼病[MCL]）病例，其中 90%发生在阿富汗、巴西、伊朗、秘鲁、沙特阿拉伯和叙利亚。目前对 CL 的治疗方法缺乏充分依据，效果也不理想。治疗可以基于局部或全身方案。这些不同的选择必须基于利什曼原虫的种类、地理区域和临床表现。在某些情况下，旧世界 CL（OWCL）病变可以自行愈合，无需任何治疗干预。局部治疗（热疗、冷冻疗法、巴龙霉素软膏、局部注射锑剂）具有较少的全身毒性，是较好的选择，可保留全身治疗（唑类药物、米替福新、锑剂、两性霉素 B 制剂）主要用于复杂病例。大多数新世界 CL（NWCL）类型需要全身治疗（主要是使用五价锑剂），以加速愈合或防止扩散到口腔-鼻腔黏膜，形成 MCL（NWMCL）。这些类型的病变可能很严重，始终需要基于全身的治疗方案，主要是锑剂和喷他脒；然而，相关的免疫疗法是有前途的。本文对 OWCL、NWCL 和 NWMCL 的治疗进行了全面的文献回顾，并根据与感染的利什曼原虫种类和地理位置相关的证据水平，提供了治疗建议。
