# Cutaneous Leishmaniasis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: CDC Yellow Book 2024 · WHO Control of the Leishmaniases Technical Report 2010 · WHO EMRO Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region (2014), p.24, under complex situations - Verified date: 2026-08 ## Verified against - CDC Yellow Book 2024 - WHO Control of the Leishmaniases Technical Report 2010 - WHO EMRO Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region (2014), p.24, under complex situations - Cutaneous Leishmaniasis - disease-level clinical article (cutaneous-leishmaniasis-full.txt) ## Treatment metadata - Meglumine antimoniate — 85 mg — injection - Referral & safety-netting (no drug therapy) - Fluconazole — 200 mg — oral.solid ## Complete treatment card ```text CUTANEOUS LEISHMANIASIS Sources: CDC Yellow Book 2024 · WHO Control of the Leishmaniases Technical Report 2010 · WHO EMRO Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region (2014), p.24, under complex situations Review status: REVIEWED against CDC Yellow Book 2024, WHO Control of the Leishmaniases Technical Report 2010, WHO EMRO Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region (2014), p.24, under complex situations, Cutaneous Leishmaniasis - disease-level clinical article (cutaneous-leishmaniasis-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - An asymptomatic papule or nodule appears at the inoculation site after a 2 to 4 week incubation [papules] - Lesions often heal on their own within 2 to 5 years, leaving a depressed scar [scarring] - Diffuse cutaneous disease begins as a painless nodule that can spread over the entire skin surface - Visceral disease features fever, an enlarged spleen, and pancytopenia [fever · splenomegaly] SIGNS - what you find (4) - A well-defined ulcer with a raised violet-colored border and epidermal breakdown - Diffuse cutaneous lesions favor the face, ears, and extensor surfaces of the knees and elbows [skin lesions] - Progressive diffuse disease can cause leonine facies - The post-kala-azar dermal rash is papular, appearing on the face and arms once visceral disease is treated [papules · rash] TESTS (6) - Tissue histopathology is the gold standard but has low sensitivity, improved by the press- imprint-smear technique - Micro-culture techniques reach up to 98.4 percent sensitivity and 100 percent specificity - An intradermal skin test reaction of 5 mm or more is considered positive - Skin testing cannot tell a past infection from an active one - PCR and nucleic acid amplification testing are increasingly used and are both sensitive and specific - Direct agglutination testing for visceral disease reaches 97 to 100 percent sensitivity and 86 to 92 percent specificity IF NOT THIS - what else fits (4) - Furuncular myiasis is on the differential for tropical skin ulcers - Lepromatous leprosy is a differential, also presenting with leonine facies - Tuberculoid leprosy presents with hypopigmented patches and plaques - Yaws causes ulcerative or nodular lesions on the lower extremities in its primary stage Source StatPearls "Leishmaniasis" - disease-level clinical article Status traced to the source above 1. MEGLUMINE ANTIMONIATE [1st line] Adult Intralesional 0.5-5 mL per session (or 20 mg Sb5+/kg/day IM/IV for 20 days) x 2-4 weeks under specialist care Peds 20 mg/kg/day [child max 850 mg] (20 mg Sb5+/kg/day IM/IV for 20 days under specialist supervision) 3kg -> 60 mg/day 4kg -> 80 mg/day 5kg -> 100 mg/day 6kg -> 120 mg/day 7kg -> 140 mg/day 8kg -> 160 mg/day 9kg -> 180 mg/day 10kg -> 200 mg/day 11kg -> 220 mg/day 12kg -> 240 mg/day 13kg -> 260 mg/day 14kg -> 280 mg/day 15kg -> 300 mg/day 16kg -> 320 mg/day 17kg -> 340 mg/day 18kg -> 360 mg/day 19kg -> 380 mg/day 20kg -> 400 mg/day 21kg -> 420 mg/day 22kg -> 440 mg/day 23kg -> 460 mg/day 24kg -> 480 mg/day 25kg -> 500 mg/day 26kg -> 520 mg/day 27kg -> 540 mg/day 28kg -> 560 mg/day 29kg -> 580 mg/day 30kg -> 600 mg/day 31kg -> 620 mg/day 32kg -> 640 mg/day 33kg -> 660 mg/day 34kg -> 680 mg/day 35kg -> 700 mg/day 36kg -> 720 mg/day 37kg -> 740 mg/day 38kg -> 760 mg/day 39kg -> 780 mg/day 40kg -> 800 mg/day 41kg -> 820 mg/day 42kg -> 840 mg/day 43kg -> 850 mg/day (capped) 44kg -> 850 mg/day (capped) 45kg -> 850 mg/day (capped) 46kg -> 850 mg/day (capped) 47kg -> 850 mg/day (capped) 48kg -> 850 mg/day (capped) 49kg -> 850 mg/day (capped) 50kg -> 850 mg/day (capped) Source WHO Control of the Leishmaniases Technical Report 2010 Why Meglumine antimoniate is not available in commercial Egyptian retail pharmacies; pentavalent antimonials are supplied via Ministry of Health/WHO programs. Caution Monitor for cardiotoxicity (QT prolongation) and pancreatitis. Unregistered in commercial Egyptian pharmacies; supplied through specialized MOH/WHO programs. Requires specialist endemic disease referral; check baseline ECG, renal and pancreatic enzymes if giving IM/IV. Egypt no Egyptian brand matched - prescribe by generic name 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Leishmaniasis - disease-level clinical article (cutaneous-leishmaniasis-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - There is a risk of severe and life-threatening mucosal disease spread. 3. FLUCONAZOLE [2nd line] Adult 200-600 mg once daily x 4-6 weeks Peds 3-6 mg/kg/day [child max 200 mg] (3-6 mg/kg once daily for 6 weeks under specialist supervision) 3kg -> 9-18 mg/day 4kg -> 12-24 mg/day 5kg -> 15-30 mg/day 6kg -> 18-36 mg/day 7kg -> 21-42 mg/day 8kg -> 24-48 mg/day 9kg -> 27-54 mg/day 10kg -> 30-60 mg/day 11kg -> 33-66 mg/day 12kg -> 36-72 mg/day 13kg -> 39-78 mg/day 14kg -> 42-84 mg/day 15kg -> 45-90 mg/day 16kg -> 48-96 mg/day 17kg -> 51-102 mg/day 18kg -> 54-108 mg/day 19kg -> 57-114 mg/day 20kg -> 60-120 mg/day 21kg -> 63-126 mg/day 22kg -> 66-132 mg/day 23kg -> 69-138 mg/day 24kg -> 72-144 mg/day 25kg -> 75-150 mg/day 26kg -> 78-156 mg/day 27kg -> 81-162 mg/day 28kg -> 84-168 mg/day 29kg -> 87-174 mg/day 30kg -> 90-180 mg/day 31kg -> 93-186 mg/day 32kg -> 96-192 mg/day 33kg -> 99-198 mg/day 34kg -> 102-200 mg/day (upper capped) 35kg -> 105-200 mg/day (upper capped) 36kg -> 108-200 mg/day (upper capped) 37kg -> 111-200 mg/day (upper capped) 38kg -> 114-200 mg/day (upper capped) 39kg -> 117-200 mg/day (upper capped) 40kg -> 120-200 mg/day (upper capped) 41kg -> 123-200 mg/day (upper capped) 42kg -> 126-200 mg/day (upper capped) 43kg -> 129-200 mg/day (upper capped) 44kg -> 132-200 mg/day (upper capped) 45kg -> 135-200 mg/day (upper capped) 46kg -> 138-200 mg/day (upper capped) 47kg -> 141-200 mg/day (upper capped) 48kg -> 144-200 mg/day (upper capped) 49kg -> 147-200 mg/day (upper capped) 50kg -> 150-200 mg/day (upper capped) Source WHO EMRO Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region (2014), p.24, under complex situations Why An oral option where the antimonials are not practical. WHO's regional manual is careful about it: the regimen has been proposed for L. major cutaneous leishmaniasis and its efficacy is variable. It sits here as a second choice, which is where that document puts it. Caution WHO EMRO records this regimen as one that has been put forward for L. major cutaneous leishmaniasis while noting that how well it works varies, and lists it under complex situations rather than as a first option. Most cutaneous leishmaniasis heals without systemic treatment, leaving a scar. Weigh a six-week azole course against that, particularly for a single small lesion not on the face. Contraindicated in pregnancy. Intralesional or systemic antimonials (meglumine antimoniate) are standard first-line in specialist centers; fluconazole is an oral alternative for L. major. Monitor liver function tests during 6-week course. Egypt ACTRIAZOLE 200 MG 2 CAPS. EGPI > RIGHT ... 51.50 EGP (25.75/unit) NAVILUCA 200 MG 7 CAPS. INTERNATIONAL... 255.00 EGP (36.43/unit) FUNGICLEAR 200 MG 2 CAPS. EGPI > HEROPHARM 74.00 EGP (37.00/unit) FUNGICLEAR 200 MG 4 CAPS. EGPI > HEROPHARM 148.00 EGP (37.00/unit) DIFLUNAZOLE 25MG/5ML SYRUP 70ML CID 28.80 EGP -> ? strength differs, ? different route - not oral solid FLUCAZONIL 25MG/5ML SYRUP 70 ML EL NILE. 28.80 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)