A Retrospective Study of the Management of Pediatric Cutaneous Leishmaniasis in a Non-endemic Setting

INTRODUCTION: Cutaneous leishmaniasis (CL), caused by protozoa of the genus Leishmania, is a neglected tropical disease. Limited evidence exists to inform the management of CL in children and adolescents, and experience in non-endemic settings varies significantly. We report case data and treatment outcomes for 17 children and young people diagnosed with CL and treated at a specialist tropical medicine center in the United Kingdom. METHODS: The electronic patient records of 17 patients less than 18 years old with CL who were treated at University College London Hospitals between October 2015 and June 2025 were accessed to gather data including demographics (age, sex, country of origin), likely country of CL acquisition, causative species of Leishmania, treatment given and treatment outcome. Causative agents included L. donovani complex (n = 6), L. major (n = 5), L. tropica (n = 4), L. Viannia subgenus (n = 1) and a Leishmania species where subgenus or species could not be determined (n = 1). RESULTS: Conservative management (2/17), oral miltefosine (9/17), intralesional meglumine antimoniate (3/17) and intravenous liposomal amphotericin B (LAMB; 3/17) were used as first-line treatment approaches in this cohort. Two patients were lost to follow-up, but complete resolution was observed in 14 of the remaining 15 patients by day 180 post-treatment initiation, with 1 child's lesion taking longer than this to fully re-epithelialize. Adverse effects of treatment were observed in 6/17 (35%) patients and were mild or moderate. CONCLUSIONS: Our data show that miltefosine, intralesional meglumine antimoniate and LAMB are effective, safe and well-tolerated treatments for children with CL in non-endemic settings. Management of children and young adults with CL may present additional complexity compared to adults, such as difficulty obtaining biopsy samples, lack of evidence for drug dosing regimens and tolerability of painful injections, which need to be administered repeatedly. Individualized treatment decisions should be made in conjunction with children, young people and their families, and a multidisciplinary approach is recommended.