The patient:

All features defining situation 1 but:

The patient:

1) Has lesions that are all limited in size (papule, nodule or ulcerated nodule less than 4 cm),

1) Did not cure despite previous care (as in situation 1)

1) Had all features defining situation 1 or 2 but did not cure despite previous care

AND

OR

OR

 2) Has less than four lesions

2) Has less than four lesions for which he asks for treatment

2) Has a lesion of 4 cm or more (plaque)

AND

AND

OR

3) Has lesions that are not potentially disfiguring or disabling (not on face,  fingers or toes).

3) Has lesion(s) located in sites compatible with local treatment

3) Has four or more lesions requiring immediate therapy

AND

AND

OR

4) Is infected with L. major (or the lesion is already self-curing)

4) Has one or more active lesion due to L. tropica or L. infantum

4) Has lesion(s) located in sites NOT compatible with local treatment

AND

AND

OR

5) Is not immunocompromised and does not suffer unbalanced diabetes.

5) Is not immunocompromised and does not suffer unbalanced diabetes.

5) Is immunocompromised or suffers unbalanced diabetes.

Wash lesions, and put dressing on lesion.

Wash lesions, and put dressing on lesion.

Wash lesions, and put dressing on lesion.

No specific antileishmanial therapy.

Use intralesional antimonials alone:  1-5 ml twice weekly for 3-4 weeks until complete cure.

Systemic treatment with pentavalent antimonials: 20mg Sb⁵⁺/kg/day x 21 days

Follow-up  at 14, 30, 45 days with a final visit at 180 days.

Follow-up  at 14, 30, 45 days with a final visit at 180 days.

Follow-up at 14, 30, 45 days with a final visit at 180 days.

Mention the possibility for the patient to come back to receive specific antileishmanial therapy if the evolution is not satisfactory.