Mucocutaneous Leishmaniasis

Mucocutaneous leishmaniasis
Mucocutaneous leishmaniasis (MCL)
Specialty	Infectious disease
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Mucocutaneous leishmaniasis is an especially disturbing form of cutaneous leishmaniasis, because it produces destructive and disfiguring lesions of the face. It is most often caused by Leishmania braziliensis, but cases caused by L. aethiopica have also been described.^[1]

Mucocutaneous leishmaniasis is very difficult to treat. Treatment involves the use of pentavalent antimonial compounds, which are highly toxic (common side effects include thrombophlebitis, pancreatitis, cardiotoxicity and hepatotoxicity) and not very effective. For example, in one study, despite treatment with high doses of sodium stibogluconate for 28 days, only 30% of patients remained disease-free at 12 months follow-up.^[2] Even in those patients who achieve an apparent cure, as many as 19% will relapse.^[3] Several drug combinations with immunomodulators have been tested, for example, a combination of pentoxifylline (inhibitor of TNF-α) and a pentavalent antimonial at a high dose for 30 days in a small-scale (23 patients) randomised placebo-controlled study from Brazil achieved cure rates of 90% and reduced time to cure,^[4] a result that should be interpreted cautiously in light of inherent limitations of small-scale studies.^[5] In an earlier small-scale (12 patients) study, addition of imiquimod showed promising results^[6] which need yet to be confirmed in larger trials.^{[citation needed]}

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