A soldier returning from deployment in Afghanistan develops a slowly enlarging, painless, ulcerating nodule on the forearm with raised indurated edges and a granular base. He has been in the endemic area for 6 months. Slit-skin smear and culture confirms Leishmania tropica. The first-line systemic treatment for cutaneous leishmaniasis in India is:
- A Intralesional sodium stibogluconate (SSG) 0.5–1 mL per lesion weekly
- B Oral miltefosine 2.5 mg/kg/day for 28 days ✓
- C Amphotericin B liposomal 3 mg/kg/day for 5 days
- D Oral itraconazole 200 mg BD
Explanation
In India, miltefosine (oral alkylphosphocholine) is first-line for visceral leishmaniasis and is used for cutaneous/mucocutaneous leishmaniasis in cases requiring systemic therapy. For single or few uncomplicated cutaneous lesions, intralesional antimonials (sodium stibogluconate) or cryotherapy are first choices. However, for multiple lesions, immunocompromised patients, or failures, oral miltefosine is the preferred systemic agent in South Asia due to high pentavalent antimony resistance. Liposomal amphotericin B is reserved for visceral leishmaniasis and resistant/immunocompromised cases.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.