The efficacy of topical ketoconazole in cutaneous leishmaniasis (CL) caused by L. major was assessed in an open trial. Ten patients with twenty two lesions of CL, confirmed by smear/or biopsy, were recruited into the study. Of the twenty two lesions treated, three increased in size and lesion characteristics worsened, ten showed no change but in nine there was some improvement in lesion characteristics. No lesion healed completely. No side effects were reported in nine. Topically applied ketoconazole is safe but does not significantly alter the course of CL. The differences in the results of systematically administered and topically applied ketoconazole may be due to differences in the pharmacokinetics of the drug when it is administered by different routes.
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