Current perspectives in the pharmacological management of cutaneous and mucosal leishmaniasis

INTRODUCTION: Leishmaniasis encompass a heterogeneous spectrum of neglected tropical diseases, with clinical course and treatment outcomes strongly influenced by Leishmania species and geographic setting. Despite recent advances, their pharmacological management remains challenging. AREAS COVERED: This review examines current therapies for cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML), focusing on their clinical efficacy, safety, mechanisms of action, and resistance. Pentavalent antimonials, amphotericin B, miltefosine, pentamidine, paromomycin, azoles, and pentoxifylline are discussed, with particular attention to the therapeutic complexity of ML and its risk of treatment failure and relapse. A narrative literature search was conducted in PubMed/MEDLINE and Scopus, covering publications from 1990 to 2026. EXPERT OPINION: Treatment should be individualized according to parasite, disease, and host characteristics, while also considering local drug availability. In ML, long-term follow-up and sustained cure are particularly important given the potential for recurrence and irreversible tissue damage. Future progress will depend on safer and shorter regimens, molecular tools to support therapeutic decisions, and host-directed strategies.