The pulsed dye laser is more effective and rapidly acting than intralesional meglumine antimoniate therapy for cutaneous leishmaniasis

Treatment of Cutaneous Leishmaniasis with Intense Pulsed Light: Is it Effective?

Background

Cutaneous leishmaniasis (CL) is a common parasitic disorder that is endemic in many countries. There is no completely effective treatment for this condition, but pentavalent antimony compounds are regarded as the main treatment. Different laser types have been used for treatment of CL with variable success but to our best knowledge, there is no published paper regarding use of intense pulsed light (IPL) for treatment of CL.

Materials and Methods

In this randomized, single-blind clinical trial study, we compared the efficacy of intralesional glucantime alone versus intralesional glucantime plus weekly IPL for treatment of 54 patients with confirmed cutaneous leishmaniasis for a maximum of eight weeks as a randomized, clinical trial.

Results

Although it was not statistically significant, combination treatment was more effective than intralesional glucantime alone (P > 0.05). However, the velocity of healing was significantly higher in the IPL plus intralesional glucantime alone versus glucantime alone. No side effect was observed in both groups.

Discussion

To better evaluate the efficacy of IPL, more studies with a higher number of patients and using various IPL filters are recommended.

Alternative Non-Drug Treatment Options of the Most Neglected Parasitic Disease Cutaneous Leishmaniasis: A Narrative Review

With more than 12 million cases worldwide, leishmaniasis is one of the top 10 neglected tropical diseases. According to the WHO, there are approximately 2 million new cases each year in foci in around 90 countries, of which 1.5 million are cutaneous leishmaniasis (CL). Cutaneous leishmaniasis (CL) is a complex cutaneous condition that is caused by a variety of Leishmania species, including L. (Leishmania) major, L. (L) tropica, L. (L) aethiopica, L. (L) mexicana, L. (Viannia) braziliensis, and L. (L) amazonensis. The disease imposes a significant burden on those who are affected since it typically results in disfiguring scars and extreme social stigma. There are no vaccines or preventive treatments available, and chemotherapeutic medications, including antimonials, amphotericin B, miltefosine, paromomycin, pentamidine, and antifungal medications, have a high price tag, a significant risk of developing drug resistance, and a variety of systemic toxicities. To work around these limitations, researchers are continuously looking for brand-new medications and other forms of therapy. To avoid toxicity with systemic medication use, high cure rates have been observed using local therapy techniques such as cryotherapy, photodynamic therapy, and thermotherapy, in addition to some forms of traditional therapies, including leech and cauterization therapies. These CL therapeutic strategies are emphasized and assessed in this review to help with the process of locating the appropriate species-specific medicines with fewer side effects, lower costs, and elevated cure rates.

An appraisal of the scientific current situation and new perspectives in the treatment of cutaneous leishmaniasis

Leishmaniasis is a Neglected Tropical Diseases caused by protozoan parasites of the genus Leishmania. It is a major health problem in many tropical and subtropical regions of the world and can produce three different clinical manifestations, among which cutaneous leishmaniasis has a higher incidence in the world than the other clinical forms. There are no recognized and reliable means of chemoprophylaxis or vaccination against infections with different forms of leishmaniasis. In addition, chemotherapy, unfortunately, remains, in many respects, unsatisfactory. Therefore, there is a continuing and urgent need for new therapies against leishmaniasis that are safe and effective in inducing a long-term cure. This review summarizes the latest advances in currently available treatments and improvements in the development of drug administration. In addition, an analysis of the in vivo assays was performed and the challenges facing promising strategies to treat CL are discussed. The treatment of leishmaniasis will most likely evolve into an approach that uses multiple therapies simultaneously to reduce the possibility of developing drug resistance. There is a continuous effort to discover new drugs to improve the treatment of leishmaniasis, but this is mainly at the level of individual researchers. Undoubtedly, more funding is needed in this area, as well as greater participation of the pharmaceutical industry to focus efforts on the development of chemotherapeutic agents and vaccines for this and other neglected tropical diseases.

Fractional CO2 laser-assisted topical rifamycin drug delivery in the treatment of pediatric cutaneous leishmaniasis

Cutaneous leishmaniasis is challenging to treat. Various drugs have been proposed to manage this condition, with variable results. In this case report, we describe laser-assisted delivery of rifamycin to treat this infection. Two sessions of fractional CO₂ laser were performed one month apart. Each was followed by a topical application of rifamycin for three days. Resolution with minimal scarring was obtained, suggesting this technique might be safe and effective in treating cutaneous leishmaniasis.

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 10 weeks. Patients were assessed every 2 weeks 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 6 months. 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.

Application of laser for treatment of cutaneous leishmaniasis: a review of literature

Cutaneous leishmaniasis (CL) is a major health problem in developing countries with high economic and health impact. Despite suggested treatment for CL, there is still no definite therapy for this infection, and many of these treatments are associated with serious local and systemic side effects. In the current paper, use of different laser types including continuous and fractional CO2, argon, PDL, erbium glass, and Nd:YAG have been reviewed. Based on our review, given the high reported efficacy and low side-effect profile, use of laser can be considered as a good alternative to standard treatment of cutaneous leishmaniasis (CL). Performing more studies using different types of lasers is recommended to evaluate the efficacy of this method for treatment of CL.

The effect of Nd:YAG laser therapy on cutaneous leishmaniasis compared to intralesional meglumine antimoniate

Introduction

Nd:YAG laser is one of the commonly used lasers in dermatology.

Aim

This study aimed to investigate the effect of Nd:YAG laser therapy (NDY) on cutaneous leishmaniasis in comparison with meglumine antimoniate (MA). Therefore, researchers are seeking to use a more effective, faster and less complicated method.

Material and methods

This study was conducted as a clinical trial on 16 patients with cutaneous leishmaniasis treated simultaneously as follows: one lesion with Glucantime and another with NDY laser in the Ahvaz Jundishapur University of Medical Sciences in 2016–2017. Then, the demographic data, number of treatment sessions, mean duration of illness before the start of treatment, post inflammatory hyperpigmentation (PIH), and scars, and recovery in two methods were recorded and compared using SPSS-21.

Results

The mean age was 14.37 ±29.68. The mean duration of disease before the study was 1.84 ±0.50 months. The mean number of Glucantime injections was 7.31 ±4.01 and the mean number of laser therapy sessions was 2.56 ±0.89; this was significantly less than that of injections of the MA group (p < 0.001). Moreover, the MA scars were observed in 10 subjects and laser scars were seen in 3 subjects. Scars in patients treated with laser were significantly smaller than in those treated with Glucantime injections (p = 0.03). 13 subjects had MA therapy-induced PIH and 15 had laser therapy-induced PIH.

Conclusions

The alternative method of laser use in the treatment of patients with cutaneous leishmaniasis can lead to complete recovery of patients in shorter time and with less complications.