Background: Cutaneous leishmaniasis is a major health problem in Iraq especially in the last decade because of forced internal displacement of population and bad infrastructure. Pentavalent antimonial drugs used as 1st line of management had many drawbacks, multiple courses, painfulness, unavailability, and emergence of resistance. Carbon dioxide laser had been used for treatment of cutaneous leishmaniasis in many studies with shorter course and better cosmetic result. Objective: to evaluate the efficacy of ablative co2 laser for treatment of active lesions of cutaneous lieshmaniasis in Iraqi patients. Patients and Methods: In this prospective therapeutic study conducted at department of dermatology in Baquba teaching hospital beginning from March 2019 to November 2020, 28 patients with total of 70 lesions of cutaneous leishmaniasis diagnosed clinically and by positive smear treated with continues ablative co2 laser and assessed at 2, 4, 8, and 12 weeks. Compared to group of 30 patients with 76 lesions treated with weekly intralesional injection of pentavalent antimonial injection. Healing defined as complete flattening of skin for both groups. Results: For group A mean age was 22.25±16.8 years, in group B mean of age is 16.10±16.4 years. There is no significant difference in number of lesions and duration of disease prior to treatment between both groups (p-value=0.915) and (p-value=0.057) respectively. Average duration of healing for group A (2.75±0.6 weeks), while in group B (5.70±1.5 weeks) with significant p-value of ˂0.001. Conclusion: Ablative co2 laser is an effective treatment for active cutaneous leishmaniasis with mostly single session treatment and shorter duration of healing.