ABSTRACT
Clinical progression, outcome, sequelae, complications, and treatment response of an infection are mostly species-dependent in leishmaniasis. Whether Leishmania donovani–induced skin lesions should be treated or should be left for self-cure is still uncertain. All skin lesions are treated in Sri Lanka. Various treatment protocols are used for this. Cryotherapy which is a nonspecific treatment method was used to treat skin lesions at the beginning of the outbreak, mainly due to its wide availability. Soon after this was replaced by sodium stibo-gluconate injections given intra-lesionally or peri-lesionally. Locally available cheap and easy-to-use treatment options (hypertonic saline, and thermotherapy) have also been examined in comparison to SSG in the treatment of cutaneous leishmaniasis. Hypertonic saline and intra-lesional liquid nitrogen treatment (cryotherapy) have shown encouraging results. Radio frequency–induced heat therapy had been tested for its efficacy, safety, and cost-effectiveness on locally acquired cutaneous leishmaniasis with single lesions. Poor treatment response with standard protocols have been reported at few occasions. Recurrence of lesions is very rare. Atypical lesions in cutaneous leishmaniasis required treatment with SSG over longer periods to achieve clinical cure. Cases of visceral leishmaniasis have been successfully treated with intra-venous SSG, amphotericin, or oral miltefosine, with no recurrences at 3-year follow-up.
