Cutaneous leishmaniasis successfully treated with photodynamic therapy: a case series

BACKGROUND: Cutaneous leishmaniasis (CL) is a parasitic skin disease caused by Leishmania spp., transmitted through infected sandflies. It manifests with lesions ranging from self-healing papules to chronic ulcerative plaques, depending on the parasite species and host immunity. Current treatments, including systemic antimonials, amphotericin B, miltefosine, and intralesional injections, are limited by systemic toxicity, invasiveness, and prolonged regimens, with additional challenges in children due to pain and poor compliance. OBJECTIVE: To evaluate the efficacy, safety, and tolerability of photodynamic therapy (PDT) using either conventional (C-PDT) or daylight (DL-PDT) protocols in adult and pediatric patients with CL. METHODS: A retrospective single-center study was conducted at the Dermatology Unit, University of Messina, Italy (January 2021-January 2025). Nine polymerase chain reaction (PCR)-confirmed CL patients (four pediatric, five adult) received three monthly sessions of either C-PDT or DL-PDT with 10% 5-aminolevulinic acid (ALA). Pain intensity was assessed using a visual analogue scale (VAS), and local or systemic adverse events were recorded. Clinical and dermoscopic outcomes were evaluated one year after the final session. RESULTS: Complete lesion clearance was observed in all patients in this cohort, with good cosmetic results and no recurrences. Median VAS scores were 6 for C-PDT and 1 for DL-PDT. Only mild transient erythema occurred, and no systemic adverse events were observed. CONCLUSIONS: Both C-PDT and DL-PDT may represent safe, effective, and well-tolerated alternatives for CL. Their non-invasive nature, minimal discomfort, and good cosmetic outcomes make PDT a potential therapeutic option for pediatric and pain-sensitive patients.