Acute Cutaneous Leishmaniasis Research Articles

Clinical Risk Factors of Systemic Antimony Treatment Failure in Patients with Acute Cutaneous leishmaniasis referred to the Dermatology Clinics of Mashhad University of Medical Sciences, Iran

Background: Systemic or topical forms of pentavalent antimony compounds such as meglumine antimoniate (MA) are used as standard treatment for cutaneous leishmaniasis (CL). However, an increasing number of studies demonstrate evidence of treatment failure with these drugs. The objective of this study was to determine the factors associated with systemic MA treatment failure in patients with acute CL. Methods: In this case-control study, patients with urban cutaneous referred to leishmaniasis clinics in Mashhad from 2017 to 2018 were followed up 12 months after the start of treatment and were evaluated for improvement or failure according to the national leishmaniasis protocol. Results: A total of 112 cases of CL (59 men and 53 women) with a mean age of 23.3±21.11 years were studied. The number of patients with clinical improvement was significantly higher in women (P=0.005). Age, body mass index (BMI), occupation and education, the possible infection and living location, past medical, drug and leishmaniasis recurrence history, lesion’s characteristics and ulceration were also significantly different between the two groups of improved and unhealed patients. Conclusion: The results of this study showed that the male sex, age less than 18 years, receiving pentostam, previous treatment history, lymphadenopathy, urban leishmaniasis, duration of illness more than 4 months, having a single lesion especially on the face, BMI less than 18 kg/m2 and a lesion size of more than 3 cm is more common in patients with treatment failure.

Higher Serum Vitamin D Levels have a Positive Association with the Incidence of Recidivans Form of Cutaneous Leishmaniasis; A Cross-Sectional Study.

Several manifestations of cutaneous leishmaniasis are related to the host's immune system and the species of parasite. There have been some studies on the relationship between vitamin D statuses in infectious diseases including cutaneous leishmaniasis. However, the results of these studies have been inconsistent. In this cross-sectional study, 147 patients with leishmaniasis were recruited and divided into the following categories: acute cutaneous leishmaniasis (<1 year) (n = 51), chronic cutaneous leishmaniasis (more than 1 year) (n = 26), and leishmaniasis recidivans (the appearance of new papular lesions around a previous scar) (n = 20), and a group of participants without leishmaniasis (n = 50), as a control group. Serum 25-hydroxyvitamin D [25(OH) D] level was analyzed. There were significant differences in serum 25(OH) D between the groups with acute or chronic leishmaniasis and those with recidivans leishmaniasis (P = 0.013 and P = 0.022, respectively). The median serum level of vitamin D in the acute group was 13.7 ng/mL, in the chronic group was 16.05 ng/mL, in the recidivans group was 21.75 ng/mL, and in the control group was 17.97 ng/mL. Higher serum concentrations of 25(OH) vitamin D levels being associated with leishmaniasis recidivans.

Comparing the Efficacy of Monotherapy with Intralesional Meglumine Antimoniate and Combination Therapy with Trichloroacetic Acid 50% and Intralesional Meglumine Antimoniate for the Treatment of Acute Cutaneous Leishmaniasis

Objective: to compare the efficacy of monotherapy with intralesional meglumine antimoniate and combination therapy with trichloroacetic acid 50% and intralesional meglumine antimoniate for treating acute cutaneous Leishmaniasis. Study Design: A randomized control trial. Place and Duration of Study: Dermatology department of DHQ hospital, Faisalabad from July 5, 2017 to July 5, 2018. Methodology: We divided 222 patients Group MA with 104 patients who were to be given intralesional MA and Group TCA+MA with 118 patients who were to be given TCA 50% and intralesional MA. Age, number of lesions, gender distribution, response to treatment in the form of complete, partial and no cure were compared between the groups. Independent t-test and chi-square tests were applied. The data was put in SPSS version 23 computer software and analyzed. P value of more than 0.05 was considered clinically insignificant. Results: There was no significant difference between the two groups in terms of age, average number of lesions and male percentage (p&gt;0.05). Complete and partial cure of papule and nodule was seen in more patients of the Group TCA+MA while the cure rates of plaque were more in the group MA (p-value 0.014, 0.019 and 0.009, respectively). There was no statistically significant difference in the cure rates of ulcerative lesions between the groups (p=0.312). Conclusion: There was significantly better cure rate in the patients who were given combination therapy of intralesional meglumine antimoniate with topical Trichloroacetic acid 50%.

The Therapeutic Effects of Nigella sativa on Skin Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The aim of this systematic review was to identify randomized controlled trials that looked at the effects of Nigella sativa in any form on different skin diseases. Up to March 2022, the online databases of Scopus, Web of Science, PubMed, Embase, Google Scholar, and Cochrane trials were searched. This study included 14 records of people who had experienced different types of skin disease including atopic dermatitis, vulgaris, arsenical keratosis, psoriasis, vitiligo, acute cutaneous leishmaniasis, warts, eczema, and acne. The mean SD age of the patients was 28.86 (4.49); [range: 18.3-51.4], with females accounting for 69% (506 out of 732) of the total. The follow-up mean SD was 8.16 (1.3) (ranged: 4 days to 24 weeks). The odds ratio (OR) was found to be 4.59 in a meta-analysis (95% CI: 2.02, 10.39). Whereas the null hypothesis in this systematic review was that lotion had no impact, OR 4.59 indicated that lotion could be effective. The efficacy of N. sativa essential oil and extract has been demonstrated in most clinical studies. However, more research is needed to completely evaluate and validate the efficacy or inadequacy of therapy with N. sativa, although it appears that it can be used as an alternative treatment to help people cope with skin problems.

Investigation of in vitro Efficacy of Miltefosine on Chronic Cutaneous Leishmaniasis

Leishmaniasis is the second deadliest parasitic disease in the World Health Organisation's list of neglected diseases, following malaria. Cutaneous leishmaniasis (CL) is the most common form of the disease and it is one of the few communicable diseases with increasing incidence rates owing to factors like armed conflicts and climate change. CL can be divided into two major groups: Acute CL (ACL) and chronic CL (CCL). The aim of this study was to compare the in vitro efficacy of miltefosine and pentavalent antimony compounds in the CCL patient samples. Five isolates previously isolated from 5 CCL patients were included in this study. Genotyping is performed using internal transcribed spacer 1 (ITS 1) gene region real-time PCR. In vitro drug efficacy tests were applied to determine their activity against meglumine antimoniate (MA) and miltefosine. Serial dilutions (512, 256, 128, 64, 32, 16, 8 and 4 µg/mL) prepared from MA and miltefosine were prepared in 96-well flat-bottom cell culture plates and incubated at 24 °C for 48 hours. The efficacy of the drug on Leishmania spp. promastigotes after 24 and 48 hours was evaluated by hemocytometer slide and XTT cell viability test. All of the samples were genotyped as L. tropica. Evaluation of 24 and 48 hours showed, 128 µg/mL and 256 µg/mL and 32 µg/mL and 64 µg/mL concentrations of miltefosine and MA were enough to kill all the promastigotes respectively. The results of the hemocytometer slide and XTT were consistent. There are no studies investigating the in vitro efficacy of miltefosine with the CCL patient group. To overcome the treatment challenges experienced in this special patient group, more studies are needed. According to our results, it is concluded that miltefosine is efficient for the treatment of CCL and further clinical studies with miltefosine will reveal valuable data.

NEW APPROACH FOR TREATMENT OF CUTANEOUS LEISHNIANIASIS BY MAN NITOL

The present study was carried outinHaWija District and surrounding villages. Three villages were chosen (Al-Kadhemia,Sader A1-Naher, A1-Ameniea). The high incidence rate of cutaneous leishmaniasis was during the Winter months (December 1996 to March 1997). The total positive cases were 227 ( 111 males and 116 females). The highest incidence rate was among childeren fiom 1-10 years old.&#x0D; Intralesional mannitol solution was shown to be more effective ( 93.89% ) than Hypertonic Sodium Chloride 7% (HSCS) ( 87.50% ) but almost identical to pentostam ( 96.20% ). Most of lesions were cured in first and second injection, in all three treated groups but few of them needed the third injection. In all three treated groups, the scar was absent&#x0D; or minimum afier healing. None of the control lesions cured-within 6-8 Weeks.&#x0D; It is concluded that 20% rnannitol is aneffective local method of treatment for acute cutaneous leishmaniasis. The efficacy of 20% of mannitol is identical to pentostam and greater than 7% “ HSCS”. i

Anti-Leishmanial Effect of Oral Zinc Sulfate in Acute Cutaneous Leishmaniasis: A Mini-review

Cutaneous Leishmaniasis (CL) is an endemic parasitic infection caused by various Leishmania species, with a specific predisposition of each species into a particular geographical area. Cutaneous lesions can either be a single, limited skin lesion or multiple, large, locally destructions skin lesions. Several therapies are proposed for CL, but severe side effects, high costs, and incomplete efficacy make researchers find replaceable therapies. Since the usage of zinc sulfate as a therapeutic agent has a long history in treating of various dermatological diseases, Zinc plays an essential role in the development and function of innate immunity cells (neutrophils and natural killer cells), which play significant roles in killing parasites. It also has a significant inhibitory effect on key enzymes involved in the carbohydrate metabolism and virulence of L. major and L.tropica. Therefore, its use as an oral therapy for CL might represent a significant addition to the armamentarium of anti-leishmanial medications. This review summarizes and discusses previous and recent findings regarding the therapeutic roles of oral zinc sulfate in cutaneous leishmaniasis therapy.

Comparison of serum zinc level in acute improved and chronic cutaneous leishmaniasis

Background: Zinc is an effective factor in the immune response against infectious agents; its effect on the course of cutaneous leishmaniasis (CL) is unknown. This study aimed to compare the serum zinc level in patients with acute and chronic CL. Methods: A descriptive study was conducted on 120 CL cases and controls. This included 30 cases of acute CL (less than one year of lesion recovery), 30 cases of chronic CL (period of illness over one year), and 60 healthy subjects with age and gender proportional to the patients. Volunteers entered the study with knowledge and consent. The serum zinc level was measured by atomic absorption spectrophotometry. Results: The percentages of people with reduced serum zinc levels in the healthy, acute, and chronic groups were 13.3, 50, and 43.3%, respectively, whereby there was a significant difference between the leishmaniasis groups (acute and chronic) and the control group (p <0.001). However, the mean serum zinc level did not differ significantly between the acute (75.36 ± 15.72 µg/dl) and chronic (73.96 ± 17.98 µg/dl) leishmaniasis groups (P=0.94). Conclusions: A reduced serum zinc level is associated with symptomatic CL, but does not affect the clinical outcome and recovery.

Overcoming the Challenge; In Vivo Efficacy of Miltefosine for Chronic Cutaneous Leishmaniasis.

Cutaneous Leishmaniasis (CL) is the most common form of leishmaniasis. CL can be divided into two major groups: acute CL (ACL) and chronic CL (CCL). The aim of this study is to compare the efficacy of miltefosin and pentavalent antimony compounds in vivo with the CCL patient samples. Three study groups were formed, each consisting of five male Mus musculus (Balb/C) mice. In this model, promastigotes from the culture of a CCL patient were utilized. 100μL L. tropica promastigote suspension with a density of 108 promastigotes/ml were injected into the hint-right footpad of each experimental animal intradermally. Footpads of the mice were measured every two weeks until 24th week. From the 13th week, miltefosin 50mg/kg/day was administered orally using gavage for 21days, Meglumin antimoniate (MA) was administered by intramuscular (IM) injection daily for 21days at 50mg/kg/day and saline was administered IM for 21days for the miltefosine, MA and control group, respectively. The footpad measurements of the miltefosine group were lower than the control group statistically. Between the MA group and the miltefosine group and MA group and the control group, there was no statistically significant difference. Giemsa stained slides revealed amastigotes in one, two and all of the slides for the miltefosine, MA and control group, respectively. Molecular tests were performed with the Rotor-Gene device and L. tropica consistent peaks were obtained in one of the miltefosine group, four in the MA group and all mice in the control group. Demonstration of both clinical and laboratory improvement in four of the five experimental animals provides strong evidence that miltefosine is an effective drug in the treatment of CCL. In the literature, no clinical or laboratory studies using miltefosine have been performed with CCL patients only.

Evaluating the effect of oral clarithromycin on acute cutaneous leishmaniasis lesions compared with systemic glucantime

Background and aim It is widely accepted that the high prevalence of leishmaniasis, demands the search for a tolerable effective treatment with the least side effects. This study aimed to evaluate the effect of treatment with clarithromycin on regression of lesions. Materials and methods This study was performed on 20 patients with leishmaniasis referred to dermatology clinic in 2017–2018. They were divided into two groups of intervention (500 mg oral clarithromycin twice a day) and control (20 mg/kg/day systematic glucantime). Induration size of lesions was recorded. Results We had 20 patients with acute cutaneous leishmaniasis (CL) with 45 lesions in the control group and 49 lesions in the intervention group. In the control group, the mean number of lesions was 3 ± 2.8 and 5 ± 4.3 in each person in the control and intervention group (p=.63). The mean size of the largest diameter of lesions’ induration at the beginning of the treatment was 19.81 ± 13 and 15.47 ± 15.6 mm in control and intervention group (p=.3) which changed to 1.59 and 0 respectively in three months after the treatment (p=.001). Conclusions We concluded oral clarithromycin had therapeutic effects on acute CL similar to systematic glucantime and could be considered as a safe and effective treatment option.

Evaluating the efficacy and safety of vascular IPL for treatment of acute cutaneous leishmaniasis: a randomized controlled trial.

Treatment of cutaneous leishmaniasis (CL) continues to be a health concern, and alternative therapies with fewer side effects are substantially needed. This study aimed to determine the efficacy of intense pulsed light (IPL) with wavelength spectrum affecting vascular lesions on acute cutaneous leishmaniasis. In this randomized clinical trial study, 30 patients with acute CL were enrolled. Baseline clinical and demographic data were recorded in the checklist after obtaining written informed consent. Patients were randomly allocated to receive either IPL fortnightly (intervention group) or intralesional meglumine antimoniate (MA) weekly (control group) over 10weeks. Patients were assessed every 2weeks to determine the size of induration and improvement rate of lesions. Follow-up visits were arranged at 3rd and 6th months. Overall, 15 patients (21 lesions) in the intervention group and 15 patients (22 lesions) in the control group were studied. The size of lesions in the control group was significantly higher at the baseline (P = 0.014) and the second week (P = 0.034), and significantly lower in the eighth week (P = 0.009), compared with the intervention group. The size of lesions in the control group changed during the study (P < 0.001), whereas changes were not significant in the intervention group. The trend of changes in size of lesions was faster in the control group (P < 0.001). More patients in the control group had higher improvement rate at the sixth (P = 0.005) and tenth (P < 0.001) weeks. At the end of study, the cure rate was 35% (7 out of 20 lesions) in intervention group and 81.8% (18 out of 22 lesions) in the control group. Complete response happened earlier in the control group (P < 0.001). None of the lesions that were cured before the tenth week relapsed after 6months. The frequency of blistering was significantly higher in intervention group (P = 0.001). Our results indicated that IPL with wavelength spectrum affecting vascular lesions was inferior to intralesional MA in treatment of CL. However, it can be considered as a second-line option, especially in patients with limitations for use of MA. Trial registry: https://www.irct.ir/trial/34246 IRCT20140414017271N5.

Immunomodulatory effects of topical diphencyprone for the treatment of acute urban cutaneous leishmaniasis

Background and objective Efficacious and safe treatments are lacking for cutaneous leishmaniasis (CL). This study investigates the efficacy of adding diphencyprone immunotherapy to conventional meglumine antimoniate (MA) treatment for acute urban CL. Methods This randomized controlled pilot study included 46 patients with acute CL. They were randomly allocated to receive either combination of diphencyprone immunotherapy with intralesional MA (intervention; N = 23) or intralesional MA alone (control; N = 23) weekly. The size and duration of lesions were measured at the baseline and after that at 4th, 8th, 12th, and 24th weeks. Data were analyzed in SPSS and p < .05 was considered significant. Results The groups showed no significant difference in duration of lesions, but number of injections was significantly higher in the control group compared with the intervention group (p < .001). Size and induration of lesions was significantly reduced in both groups during the course of study (p < .001). The intervention group showed significantly lower induration of lesions in 4th, 8th, and 12th week compared with controls (p < .05). Conclusion Combination of diphencyprone with MA resulted in earlier resolution of acute CL lesions with a relatively acceptable rate of adverse effects, compared with intralesional MA alone.

A Comparative Evaluation of Regulatory T Cells Profile among Acute and Chronic Cutaneous Leishmaniasis Using Flow Cytometry

Cutaneous leishmaniasis (CL) is described as a major health problem in many countries of the world. Regulatory T cells (Tregs) are characterized as one of immunologic indexes. One of the best methods to determine of Tregs percentage is flow cytometry. The aim of this study was determination of the role of Tregs profile among acute and chronic forms of human CL using flow cytometry analysis. This study was conducted on 24 patients referred to Laboratory of Leishmaniasis, Tehran University of Medical Sciences, Tehran, Iran with acute and 14 patients with chronic phases of CL as well as 15 healthy individuals as control group in 2015-2016. After microscopic examination, 2 ml of peripheral blood samples were collected for determining percentage of CD4 + CD25 + CD127 low Tregs by using flow cytometry method. Using flow cytometry analysis, the average percentage of Tregs were calculated 5.73, 6.71 and 6.61 for acute, chronic and healthy individuals, respectively. With SPSS software and Scheffe multiple comparison tests, the differences within in these groups are statistically significant (P=0.04) and between the acute and chronic group, there was marginally significant with approximately 91% of confidence level (P=0.088). Marginally differences were found significantly among averages of Regulatory T cells, acute and chronic phases of CL. Further comprehensive studies can be needed to verify the role of Tregs in both phases of CL cases.

Resolution of Cutaneous Leishmaniasis and Persistence of Leishmania major in the Absence of Arginase 1.

Arginase (Arg) 1 is expressed by hematopoietic (e.g., macrophages) and nonhematopoietic cells (e.g., endothelial cells) and converts l-arginine into ornithine and urea. The enzyme is implicated in tissue repair but also antagonizes the production of NO by type 2 NO synthase in myeloid cells and thereby impedes the control of intracellular parasites such as Leishmania major In this study, we tested whether Arg1 is required for spontaneous healing of acute cutaneous leishmaniasis in C57BL/6 mice and for lifelong parasite persistence in draining lymph nodes (dLNs) of healed mice. In vitro, bone marrow-derived macrophages and lymphoid endothelial cells readily expressed Arg1 in response to IL-4 and/or IL-13, whereas skin or dLN fibroblasts failed to do so, even during hypoxia. In vivo, Arg1 was found in skin lesions and, to a much lower extent, also in dLNs of acutely infected C57BL/6 mice but became undetectable at both sites after healing. Deletion of Arg1 in hematopoietic and endothelial cells using Tie2Cre+/-Arg1fl/fl C57BL/6 mice abolished the expression of Arg1 in skin lesions and dLNs but did not affect development and resolution of skin lesions, parasite burden, NO production, or host cell tropism of L. major during the acute or persistent phase of infection. Similar to wild-type controls, parasites persisting in Arg1-deficient mice favored NO synthase 2-negative areas and mainly resided in myeloid cells and fibroblasts. We conclude that Arg1 expression by hematopoietic and endothelial cells is completely dispensable for clinical resolution of cutaneous leishmaniasis and for long-term persistence of L. major.

Prevalence and Epidemiologic Profile of Acute Cutaneous Leishmaniasis in an Endemic Focus in Southeast Iran

Background: Cutaneous leishmaniasis is a zoonotic disease, which is a public health problem in tropical and subtropical countries including Iran. Objectives: This study aimed to study the prevalence and epidemiologic profile of acute cutaneous leishmaniasis in an endemic focus in southeast Iran. Methods: In this cross-sectional study, all patients with suspected cutaneous leishmaniasis referred to health centers and health networks in Sistan and Baluchistan province since the beginning of 2013 to March 2015 were examined. Then, the collected data were prepared in the form of tables using SPSS and were analyzed by tests. Results: The percentage of leishmaniasis in men was higher than in women and there was a statistically significant difference between men and women regarding the infection rate of the disease. The results suggest a difference in the site of lesions on the body indicating confrontation with a new form of disease epidemiology. Thus, alongside the ongoing epidemiological studies, there is a need for further research in all aspects including the causes, reservoirs, hosts, prevention measures and treatments in order to control the disease.

Evaluation of the efficacy of intralesional Glucantime plus niosomal zinc sulphate in comparison with intralesional Glucantime plus cryotherapy in the treatment of acute cutaneous leishmaniasis, a randomized clinical trial.

Current treatment modalities in cutaneous leishmaniasis have low efficacy and high toxicity as well as high rate of resistance to treatment. In this study, for the first time we decided to evaluate efficacy of intralesional Glucantime plus niosomal zinc sulphate in comparison with intralesional Glucantime plus cryotherapy in the treatment of acute cutaneous leishmaniasis. This is a case-control study on 64 patients with cutaneous leishmaniasis in Kerman-Iran. Patients were categorized in 2 groups A and B whom were treated with weekly intralesional meglumine antimonite plus twice daily niosomal topical zinc sulphate versus weekly intralesional Glucantime plus every other week cryotherapy, respectively. We assessed the efficacy of treatment modalities (as partial and complete response) and their adverse effects by measuring size of the lesions every 2weeks up to maximum of 12weeks and 3months after the end of the treatment. Partial response rate was 16.6% and 12.9% in group A and B, respectively (P = 0.784). Complete response rate was 73.3% and 80.6% in group A and B, respectively (P = 0.784). Complete response rate was achieved in 4.73 ± 0.29weeks and 4.69 ± 0.28weeks in group A and B, respectively (P = 0.925). Partial response rate was achieved in 2.92 ± 0.23weeks and 2.65 ± 0.18weeks, respectively (P = 0.365). Combination of niosomal zinc sulphate with intralesional Glucantime has equal efficacy versus combination of cryotherapy plus intralesional Glucantime in the treatment of acute cutaneous leishmaniasis. So, it can be used in cases that have resistance to first-line treatments.

Lived Experiences of Patients Suffering from Acute Old World Cutaneous Leishmaniasis: A Qualitative Content Analysis Study from Iran

The aim of this study was to explore the experiences of patients who suffer from acute cutaneous leishmaniasis in Iran, focusing on quality of life. The study was conducted at two different sites in Iran in 2010-2011. Individual in-depth interviews were conducted with six men and six women parasitologically confirmed acute cutaneous leishmaniasis. Interviews were recorded, transcribed verbatim, and translated into English. Qualitative content analysis was used for data analysis. The participants, aged 23 to 63yr, had mild to severe disease. Based on the analysis four main themes were developed. "Fearing an agonizing disease" reflects patients' experiences of disease development resulting in sadness and depression, "struggling to cope" and "taking on the blame" both illustrate how patients experience living with the disease, which included both felt and enacted stigma as major social concerns. "Longing for being seen and heard" refers to patients' experiences with healthcare as well as their expectations and demands from communities and healthcare to be involved in closing the knowledge and awareness gap. Mental and social dimensions of cutaneous leishmaniasis were complex and adversely affected patients' lives by causing psychological burden and limiting their social interactions. Health authorities have to plan programs to increase the disease awareness to prevent the existing stigma to improve patients' social condition and medical care.

The Safety of Oral Ketoconazole in the Treatment of Skin Diseases (Single Blinded, Therapeutic, Comparative Study)

Background: Ketoconazole was introduced in 1981 as the first in a series of antifungal agents that are characterized by nitrogen-containing ring. Ketoconazole acts against many different kinds of fungi such as candida, dermatophytes and as pergillus. Also oral ketoconazole had proved its effectiveness in the treatment of cutaneous Leishmaniasis. Objective: To evaluate the safety of oral ketoconazole in the treatment of different skin diseases like cutaneous Leishmaniasis (CL), tineacapitis, tineacorporis and tineaversicolor. Patients and Methods: This is a single, blinded, therapeutic, controlled study that was carried out in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq, during the time, January 2015 to July 2016. In total, 951 patients with acute cutaneous leishmaniasis, tineacapitis, tineacorporis and tineaversicolor were enrolled in this study. The diagnosis was confirmed by smear and histopathology. Patients were divided into two groups: 51 patients in Group 1; 24 of them were treated with oral ketoconazole tablets 200 mg twice daily for 6 weeks and 27 of them were treated orally with a combination of zinc sulfate 10 mg/kg/day and ketoconazole for 6 weeks. All patients were seen regularly every 2 weeks for 6 weeks of treatment period, then monthly for the next three months as follow up period. Liver enzymes monitoring was done for every patient in this study every two weeks. Elevated liver enzymes were considered as features of hepatotoxicity in the examined patients. While group 2 included 900 patients and was divided into 3 subgroups: A: 600 patients with tineacapitis and tineacorporis, B: 100 patients with tineaversicolor, and C: 200 patients with CL. All patients in group 2 were treated with oral KC tablets 200 mg twice daily for 6 weeks. The dose of oral KC in children is 3.3 - 6.6 mg/Kg/day. All patients in group 2 were not investigated for ketoconazole biochemical side effects but watched for any clinical symptoms and signs of any side effects. Results: After six weeks, 951 patients had completed the treatment. In the first group (51 patients), only two out 27 patients (7.4%) from the combined group showed elevated liver enzymes while the ketoconazole treated group showed no increase in liver enzymes, hence only 3.9% showed elevated liver enzymes that went to normal during follow up. In the second group (900 patients) there were no clinical symptoms and signs in favor of hepatic toxicity or other related organs. Conclusion: Ketoconazole has been used tremendously in treating of different skin diseases including fungal and Leishmania infection but without side effects, accordingly this drug seems safe to be used in treatment of different skin diseases whether adults or children.

Dermoscopy of acute cutaneous leishmaniasis

Dermoscopy of acute cutaneous leishmaniasis

Topical Therapy of Acute Cutaneous Leishmaniasis Using Zinc Sulphate Solution 25% versus Podophyllin Solution 25%

Background: Zinc sulphate as intralesional and oral therapy was used as a successful therapy in treatment of cutaneous leishmaniasis while 25% topical podophyllin is now commonly used in the treatment of cutaneous leishmaniasis. Objective: To treat acute cutaneous leishmaniasis using topical zinc sulphate solution 25% to be compared with topical podophyllin solution 25%. Patients and Methods: This is a single, blind, interventional, comparative study done in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from January 2015 to June 2015. Forty patients with a total 88 lesions of acute cutaneous leishmaniasis were enrolled in this study; 54 (61.36%) were dry lesions and 34 (38.6%) were ulcerative type. The duration of lesions ranged from 2 - 11 (7.7 + 2.483) weeks. The size of the lesions ranged from 0.3 to 8 (2.13 ± 1.53) cm. There were 21 females and 19 males, female to male ratio (1.1:1) and their ages ranged from 1 to 60 (25.92 ± 16.59) years. Diagnosis was confirmed by tissue smear and histopathology. Lesions were divided into two groups with matching types and sizes, and scored according to Sharquie modified Leishmania score to assess the objective response to the topical or systemic therapy and then during follow up responses were graded into mild, moderate, marked response and complete clearance. Group A treated with topical 25% podophyllin solution once weekly for a maximum of 6 weeks, while group B was treated with topical 25% zinc sulphate solution twice daily for 6 weeks. Follow up was every 2 weeks during therapy, and once monthly for 3 months after therapy. Results: A total of 40 patients with clinical diagnosis of acute cutaneous leishmaniasis were included in this study, with a total of 88 lesions. Fifteen (37.50%) patients had single lesion and 25 (62.50%) patients had multiple lesions. Family history of CL was positive in 42.5% of patients. At the end of six weeks after starting therapy, the total cure rate in patients treated by topical podophyllin (both marked and complete responses) was seen in 32 (82%) lesions, while the cure rate in patients treated by topical zinc sulphate was in 36 (73.4%) lesions. There was no statistical significant difference between the cure rates of both groups. No important local or systemic side effects were seen in any patients. Conclusion: Topical zinc sulphate 25% is an effective simple non-invasive non-costly safe topical therapy for cutaneous leishmaniasis and without any contraindications for its use and free of side effects and was as effective as topical podophyllin.