Cutaneous leishmaniasis (CL) is an important public health problem in Brazil, caused mainly by Leishmania (Viannia) braziliensis, representing more than 90% of the total cases. CL is predominantly found in adult males exposed to forest regions. In recent years the epidemiology of CL has changed, affecting also women, children, and the elderly. CL in the elderly results in a therapeutic challenge, since pentavalent antimony (Sbv) is not recommended in this age group where heart, liver or kidney disease are commonly found. In this context, liposomal amphotericin B may become an attractive systemic therapy in this group, due to potential less toxicity and better efficacy. However, there is little experience and a lack of data in the literature regarding its use in CL and the better low dosage associated with few toxicity and good efficacy. The present study was a randomized controlled and double blinded trial aimed to identify the dose of liposomal amphotericin B associated with the highest cure rate in the elderly. Thirty- two patients from the endemic area of Corte de Pedra, Bahia, Brazil aged 60 years or older of both genders, with localized and ulcerated CL were included. Diagnosis was confirmed upon a positive PCR for L. braziliensis in tissue obtained from ulcers. The groups were treated with liposomal amphotericin B (AmBisome®) with three different total doses after randomization: Group 1 (G1) received a total dose of 12 mg/kg (10 patients). Group 2 (G2): 18 mg/kg (10 patients). Group 3 (G3): 24 mg/kg (12 patients). The drug was used twice a week in an outpatient hospital care. Clinical and laboratory assessments were performed before the start of therapy (D0), and at D15, D30, D60, D120 and D180. The average ages of groups G1, G2 and G3 were: 68.5; 72.5 and 67.4 respectively. The number of lesions ranged from 1 to 3 (median 1.5) with no differences between the groups. The lowest healing time (days) was 57.0 (G3) compared to 92.5 (G1) and 67.5 (G2). Failure rates in groups G1, G2 and G3 were 15%, 37.5% and 0% respectively. Regarding side effects, there were no differences between the groups; mild and transient raised levels of creatinine and/or BUN were documented in less than 30% of subjects. Only one patient (G2) interrupted therapy due to anaphylaxis that was controlled. CL in the elderly represents a therapeutic challenge in L. braziliensis endemic regions due to its aggressivity, contra indication of Sbv, and potential toxicity for deoxycholate amphotericin B. When systemic therapy is indicated and miltefosine is not available or fails, liposomal amphotericin may be a good option. There is a lack of trials with this drug in cutaneous and mucosal leishmaniasis, mainly in the elderly. Our trial contributes to indicate a safe and effective total dosage in CL treatment in this age group. The total dosage of 24 mg/kg has a high rate of cure and is safe for the treatment of CL in the elderly