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Wound care, local therapy cured most patients with cutaneous leishmaniasis
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Most patients with cutaneous leishmaniasis can be managed with just wound care or local therapy, researchers from the Cutaneous Leishmaniasis French Study Group reported.
Because systemic agents for cutaneous leishmaniasis are associated with toxicity, international and national guidelines for cutaneous leishmaniasis favor options that increase the likelihood of rapid healing of lesions with the smallest risk of severe adverse events, according to the researchers.
“Unspecific wound care followed by patience, a cheap treatment devoid of toxicity, has been recommended, but the proportion of patients who can actually benefit from it has not been determined,” the researchers wrote in Clinical Infectious Diseases.
The study included 135 patients with confirmed cutaneous leishmaniasis during a 6-year period. There were 10 types of Leishmania species identified and the infections were acquired in 29 different countries. All patients but one had the lesions for 36 months or less.
The final analysis included 109 patients with evaluable charts. Twenty-five patients received simple wound care, and 23 (92%) of these had positive outcomes at days 42 to 60. Forty-seven patients were treated with cryotherapy and intralesional injections of antimony and 37 (79%) of these were cured by days 42 to 60. In the 37 patients who received systemic therapy, the cure rate was 60%. Fifteen patients experienced systemic adverse events, and all were treated with systemic therapy.
“When available, [a new formulation of topical aminoglycosides] will replace simple wound care and cryotherapy with intralesional injections of antimony, thus resulting in further simplification of treatment strategies,” the researchers wrote. “Only lesions of eyelids, lips, genitalia and mucosae are ineligible for topical therapy, ie, 10% of the lesions in our experience. A vast majority of patients will thus benefit from this inexpensive approach.”
Disclosure: The researchers report no relevant financial disclosures.
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