Efficacy of imiquimod 5% cream as first-line management in cutaneous leishmaniasis caused by Leishmania mexicana

Abstract

Cutaneous leishmaniasis (CL) involves several differential diagnoses as it lacks a gold standard diagnostic test. Its diagnosis is easier in endemic regions; however, many cases come from travelers to endemic areas. A 22-year-old patient, who had recently visited Oaxaca, Mexico, developed two asymptomatic ulcers weeks later on the left auricle and the nose. Leishmania mexicana was identified using polymerase chain reaction. The patient was treated with imiquimod 5% cream three times/week, providing favorable results after 12 weeks, without relapse 2 months after therapy. To our knowledge, this is the first case of CL due to L. mexicana effectively treated with imiquimod.

Reviewing the Etiologic Agents, Microbe-Host Relationship, Immune Response, Diagnosis, and Treatment in Chromoblastomycosis

“…Imiquimod is a Toll-like receptor 7/8 agonist (Figure 7(c)), which can stimulate the immune response, through dendritic cell activation and macrophage polarization to the M1 subset, and in T cells, it can drive the immune response to a Th1 immune pole [188]. Therefore, imiquimod appears to be an interesting adjuvant for the treatment of intracellular pathogens, as has been shown in other infectious diseases [189] that the Th1 immune response is downregulated, as is the case of leishmaniasis [190]. The first study showed that imiquimod alone or associated with itraconazole or itraconazole plus terbinafine significantly improved the lesions of four patients with CBM caused by F. pedrosoi [191].…”

“Chiclero’s Ulcer” Due to Leishmania mexicana in Travelers Returning from Central America: A Case Report and Review of the Literature

“…We performed a review of the literature in Medline in the English language using the following keywords "Cutaneous leishmaniasis", "Leishmania mexicana" AND "travel" OR "traveler". We found 12 references reporting a total of twenty-eight humans cases of CL caused by L. mexicana in travelers (Table 1) [1,3,[5][6][7][8][9][10][11][12][13]. Most cases were reported in male travelers returning from Belize, followed by Mexico.…”