How to Treat Cutaneous Leishmaniasis with Black Salve
First, there are many people making and selling black salve. We have found, however, that the salves with the fewest ingredients work the best on leishmaniasis; although, they must include North American bloodroot, galangal (an Asian plant of the ginger family) and zinc chloride. Dee tried a number of brands available online, until she discovered that the black salve from Cleansing Time™ was the most effective—some other's didn't work at all.
Week One
- It's important to explain to the patient that the treatment will hurt for a few days, but that you will give them medication to ease their pain. It usually consists of 8-10 200mg Ibuprofen tablets for adults, or a liquid pain medication for children.
- Identify that your patient is infected with the Leishmaniasis parasite. (Follow some of the links in the sidebar to see examples.)
- Soak a cotton ball with hydrogen peroxide and clean the area.
- Apply the black salve with a toothpick or other small wooden implement. (Important!—Do not use anything with metal.) Cover the ulcerated areas completely. Sometimes patients come with just small bites, in which case, apply the black salve only on the bites. You don't need to spread the entire area or cover good skin with the paste.
- Spread vaseline with a Q-tip or toothpick over the black salve. The purpose of this is to keep the salve moist and soft. You don't want it to dry out. Avoid getting the vaseline on good skin, however, as it will cause irritation.
- Next cover the wound with gauze pads or bandages, tape and wrap it, if possible (3M's Vetrap™ is ideal for this). We use unsterilized gauze bandages that come in packages of 2x2, 3x3 and 4x4 sizes. On fingers, hands, arms, legs and feet, you can just tape the gauze in place and then wrap the area.
In the humid tropics of Panama we find that paper medical tape works best. The self-adhering wrap (Vetrap™ or other brand) has been the key to keeping these wounds closed and dry. On faces, ears, and other areas that can't be wrapped, you'll need to get creative in order to tape the gauze on so that it doesn't come off. On children, this can be difficult, but it's not impossible and you just have to work at it.
- At this point, you must stress to the patient or the patient's parents that the bandage needs to be kept closed and dry. It is also critical that they return to the clinic the following week.
Week Two
- Remove the bandages. As you have seen in the photos, if everything was done properly, the parasite usually comes out with the bandage. Clean the wound with Chlorhexidine—also called "Hex." We keep ours in spray bottles. We spray a cotton ball and clean the wound with that. Pack the wound with Redmond Clay that has been mixed to form a paste. We use Q-tips to apply it. Put vaseline on top of the clay to keep it from drying out. It needs to stay soft under the bandage for a week. Apply the bandages the same way you did before. Once again, remind the patient to keep the bandage closed and dry.
If all or part of the parasite doesn't come out, there's no need to reapply black salve. Normally, the black salve will still be stuck to the part that didn't come out, so just clean the area with hydrogen peroxide, cover raw flesh with Redmond clay, then reapply vaseline and bandage as usual—allowing the salve to work for another week.
In case the black salve doesn't stick to the parasite, then you can apply a little more salve, but just on the parasite. Clean, vaseline and bandage.
- If the parasite doesn't come out all at once, but appears to be loose, you can take a toothpick and gently remove the plug. If it won't come out, then it's not ready. Clean the area with hydrogen peroxide, re-apply some vaseline on the black salve, re-bandage, letting the black salve work for another week.
- In most cases, the parasite will die and come out on the bandage. However, for people who have had injections, or if the patient has removed the bandage and the black salve has dried, it will take longer.
Week Three
- Remove the bandages. Clean off the clay with Chlorhexidine. It should come off easily. If the clay has hardened, as is sometimes the case when the patient has opened or removed the bandage, apply a cotton ball soaked with Chlorhexidine to soften the clay. Use a toothpick to pick it away as much as possible. Redress the wound with fresh clay and vaseline. Wrap with gauze or bandages.
- Continue the clay treatment until the wound is completely healed. We sometimes send patients home with a small bag of mixed clay to put on their wound at night. We also will send them home with Cacao Butter, if they are worried about scarring.
