The influence of treatment on the development of leishmaniasis recidiva cutis: a 17‐year case–control study in Midwestern Brazil

Background The recurrence of American cutaneous leishmaniasis ( ACL ) in patients experiencing a long‐term cure is often called leishmaniasis recidiva cutis ( LRC ). LRC is considered an unusual form of ACL . Objective This study aims to estimate the incidence of LRC in ACL patients evaluated at a tertiary dermatologic centre in Midwestern Brazil. We also aim to evaluate the association between various treatment regimens and the development of LRC using multivariate analysis in a case–control study. Methods We performed a 17‐year epidemiological study using data from patients treated at our dermatologic centre from July 1994 to December 2011. A retrospective analysis was then performed to estimate risk and protective factors related to clinical presentation. We also assessed the influence of treatment regimens in the development of LRC . Results The incidence of LRC among ACL patients was 1.34%. The analysis included 105 patients; 82 patients (78%) were in the control group, and 23 patients (22%) were in the LRC case group. The data analysis indicated that the standard treatment N‐methylglucamine antimoniate (N‐ MA ) reduced the development of LRC in bivariate (odds ratio ( OR ) = 0.34; 95% CI  = 0.13–0.91) and multivariate analyses ( OR  = 0.16; 95% CI  = 0.03–0.86; P  = 0.03). However, no differences in LRC incidence were observed when the standard treatment N‐ MA and alternative drugs, such as pentamidine and amphotericin B, were considered ( OR  = 0.47; 95% CI  = 0.16–1.35) Conclusion We conclude that the standard treatment N‐ MA , as proposed by the Brazilian Ministry of Health, is effective in the prevention of LRC . Although other drugs have shown promising results in LRC , more scientific evidence is needed to assess their efficacy compared with N‐ MA .