Document Detail


Tropical medicine rounds: Treatment of Old World cutaneous leishmaniasis with dapsone, itraconazole, cryotherapy, and imiquimod, alone and in combination.
MedLine Citation:
PMID:  19673049     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cutaneous leishmaniasis (CL) is a major public health problem. The currently available therapies are expensive, not freely available, toxic, and not always curative. A simple, effective, noninvasive therapeutic approach is required for the treatment of CL.
AIMS: To determine the clinical patterns of CL and to report our experience in the management of CL.
METHODS: One hundred and ten patients with CL seen between January 2005 and December 2007 were included in this study. The diagnosis was based on clinical features, parasitologic diagnosis, histopathology, and culture. Each patient was treated according to disease severity with either topical (cryotherapy or imiquimod) or systemic (itraconazole or dapsone) monotherapy, or a combination of these modalities.
RESULTS: CL was more common in adult expatriate men, with the upper limbs as the most commonly affected site. Noduloulcerative CL was the most common presentation (84.6%). Atypical CL was found in 18 patients. Skin biopsy was the most common diagnostic technique (66.6%). Monotherapy showed an overall success rate of 56.41%, whereas combination therapy was successful in 69.56% of cases. Cryotherapy alone was successful in 68.18% of cases. Imiquimod alone was ineffective.
CONCLUSION: A stepwise approach represents a rational and practical way of confirming CL. A combination of itraconazole/dapsone and topically applied imiquimod is safe, simple, and effective for the treatment of CL. More studies are needed to establish the role of such an approach. Cryotherapy is also safe, simple and effective for the treatment of CL.
Authors:
Nawaf Al-Mutairi; Mazen Alshiltawy; Mohamed El Khalawany; Arun Joshi; Bayoumy Ibrahim Eassa; Yashpal Manchanda; Samir Gomaa; Ibrahim Darwish; Manish Rijhwani
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of dermatology     Volume:  48     ISSN:  1365-4632     ISO Abbreviation:  Int. J. Dermatol.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-08-11     Completed Date:  2009-10-29     Revised Date:  2011-07-08    
Medline Journal Info:
Nlm Unique ID:  0243704     Medline TA:  Int J Dermatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  862-9     Citation Subset:  IM    
Affiliation:
Department of Dermatology, Institutional Affiliation, Farwaniya Hospital, Kuwait. nalmut@usa.net
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MeSH Terms
Descriptor/Qualifier:
Adjuvants, Immunologic / administration & dosage
Adolescent
Adult
Ambulatory Care Facilities
Aminoquinolines / administration & dosage*
Anti-Infective Agents / administration & dosage
Antiprotozoal Agents / administration & dosage
Combined Modality Therapy
Cryotherapy*
Dapsone / administration & dosage*
Drug Therapy, Combination
Female
Humans
Itraconazole / administration & dosage*
Kuwait
Leishmaniasis, Cutaneous / drug therapy*,  pathology
Male
Middle Aged
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Adjuvants, Immunologic; 0/Aminoquinolines; 0/Anti-Infective Agents; 0/Antiprotozoal Agents; 80-08-0/Dapsone; 84625-61-6/Itraconazole; 99011-02-6/imiquimod
Comments/Corrections
Comment In:
Int J Dermatol. 2011 Jun;50(6):754   [PMID:  21595678 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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