Parenteral pentavalent antimonials remain the standard therapy for cutaneous leishmaniasis. More effective and patient-compliant topical treatments are an important alternative treatment for the localized self-limiting forms of this disease. Two paromomycin ointments are commercially available but their use is limited by either toxicity or lack of efficacy. Other topical formulations have been in clinical trials, but many results have been equivocal and no major breakthroughs have been achieved. The focus of this review is on recent developments in the field of topical treatment for cutaneous leishmaniasis and rational approaches to enhance topical drug absorption.