Abstract
Cutaneous leishmaniasis (CL) is a disfiguring illness caused by Leishmania species of protozoa, with over 350 million people at risk worldwide [1]. Leishmania parasites enter the skin through a sandfly bite, producing a papule or nodule that generally ulcerates [1]. Spontaneous resolution of CL ulcers may take months to years [2], and both active lesions and scars can engender stigma and cause disability [3]. There is no consensus regarding the optimum therapy for CL, and no single treatment approach fits all possible clinical presentations [1], [2]. However, because systemic treatments may produce considerable toxicity [1], [2], [4], localized therapy (e.g., intralesional antimonials, cryotherapy, thermotherapy, or intralesional injections plus cryotherapy) is now recommended in Old World CL (L. major, L. tropica) and in selected cases of New World CL [1], [2]. However, all present local therapy modalities have limitations, e.g., variable cure rates, pain, challenges and complexities associated with treatment administration (especially in children), and variable utility in patients with multiple lesions or lesions located on body areas where local treatment is impractical [1], [2], [5].
Highlights
Cutaneous leishmaniasis (CL) is a disfiguring illness caused by Leishmania species of protozoa, with over 350 million people at risk worldwide [1]
There is no consensus regarding the optimum therapy for CL, and no single treatment approach fits all possible clinical presentations [1,2]
All present local therapy modalities have limitations, e.g., variable cure rates, pain, challenges and complexities associated with treatment administration, and variable utility in patients with multiple lesions or lesions located on body areas where local treatment is impractical [1,2,5]
Summary
Cutaneous leishmaniasis (CL) is a disfiguring illness caused by Leishmania species of protozoa, with over 350 million people at risk worldwide [1]. WR 279,396, which is a novel hydrophilic formulation of 15% paromomycin and 0.5% gentamicin, was developed at the Walter Reed Army Institute of Research as an efficacious, practical, and safe topical treatment for uncomplicated CL, in which the numbers and locations of CL lesions and the risk for disease dissemination are consistent with the use of a topical or other local treatment rather than a systemically acting drug. Paromomycin has proven antileishmanial activity in vitro and is effective when administered parenterally for visceral leishmaniasis (VL) [1]. The inclusion of gentamicin, an aminoglycoside proven to attenuate Leishmania parasites [6], has increased the antileishmanial efficacy of paromomycin in rodents [5,7,8].
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