Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Efficacy of Intralesional Meglumine Antimoniate (Glucantime) versus a Combination of Topical Trichloroacetic Acid 50% and Local Heat Therapy by Non-Ablative Radiofrequency on Cutaneous Leishmaniasis Lesions

Document Type : Original Article (s)

Authors
Mohammad Ali Nilforoushzadeh 1
Farahnaz Fatemi Naieni 2
Narges Sattar 3
Elaheh Haftbaradaran 3
1 Associate Professor, Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran and Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
3 General Practitioner, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Cutaneous leishmaniasis (CL) is an endemic disease in Iran. Pentavalent antimonial drugs have been the first line of therapy in CL for many years. However, the cure rate of these agents is still not favorable. This study was carried out to compare the efficacy of intralesional glucantime and topical trichloroacetic acid 50% in combination with non-ablative radiofrequency heat therapy on cutaneous leishmaniasis.Methods: A total of 30 patients with 38 lesions were treated with intralesional injection of meglumine antimoniate (Glucantime) (Sanofi-Aventis, France) as Group 1. An equal number of 38 lesions in the remaining 30 patients were treated with the combination of non-ablative radiofrequency and topical trichloroacetic acid 50% as Group 2. Complete cure rate besides changes in lesion size and size of scars were assessed and compared between the two groups. Data was then analyzed by SPSS.Findings: Complete cure at after 4 months of treatment was significantly more in Group 1 than the other group (P = 0.01). However, the complete cure rate at the 6th month was not significantly different between the two groups (P = 0.06).Conclusion: This study showed that intralesional glucantime has significantly higher cure rate of cutaneous leishmaniasis in shorter time than trichloroacetic acid 50% in combination with non-ablative radiofrequency. Moreover, it could significantly induce efficient size reduction of more than 50% in most of lesions. The analyses revealed that intralesional glucantime still has the superiority to be the first line of therapy in cutaneous leishmaniasis.
Keywords
Meglumine antimoniate (Glucantime)
Trichloroacetic acid
Non-ablative radiofrequency
Cutaneous leishmaniasis
Scar
  1. Berman JD. Human leishmaniasis: clinical, diagnostic, and chemotherapeutic developments in the last 10 years. Clin Infect Dis 1997; 24(4): 684-703.
  2. World Health organization. Tropical Disease Research. 12th Program Report. UNDP/ World Bank/ WHO Special Program for Research and Training Disease (TDR). Geneva: WHO; 1995.
  3. Nilforoushzadeh MA, Jaffary F, Derakhshan R, Haftbaradaran E. Comparison between intralesional meglumine antimoniate and combination of trichloroacetic acid 50% and intralesional meglumine antimoniate in the treatment of acute cutaneous leishmaniasis. Skin and Leishmaniasis 2010; 1(1): 18-22.
  4. Hepburn NC. Cutaneous leishmaniasis: an overview. J Postgrad Med 2003; 49(1): 50-4.
  5. Nadim A, Seyedi-Rashti MA. A brief review of the epidemiology of various types of leishmaniasis in Iran. Acta Medica Iranica 1971; 14: 99-106.
  6. Momeni AZ, Aminjavaheri M. Successful treatment of non-healing cases of cutaneous leishmaniasis, using a combination of meglumine antimoniate plus allopurinol. Eur J Dermatol 2003; 13(1): 40-3.
  7. Dowlati Y. Cutaneous leishmaniasis: clinical aspect. Clin Dermatol 1996; 14(5): 425-31.
  8. Nilforoushzadeh MA, Jaffary F, Moradi S, Derakhshan R, Haftbaradaran E. Effect of topical honey application along with intralesional injection of glucantime in the treatment of cutaneous leishmaniasis. BMC Complement Altern Med 2007; 7: 13.
  9. Asilian A, Sadeghinia A, Faghihi G, Momeni A, Amini HA. The efficacy of treatment with intralesional meglumine antimoniate alone, compared with that of cryotherapy combined with the meglumine antimoniate or intralesional sodium stibogluconate, in the treatment of cutaneous leishmaniasis. Ann Trop Med Parasitol 2003; 97(5): 493-8.
  10. Sadeghian G, Nilforoushzadeh MA. Effect of combination therapy with systemic glucantime and pentoxifylline in the treatment of cutaneous leishmaniasis. Int J Dermatol 2006; 45(7): 819-21.
  11. Layegh P, Pezeshkpoor F, Soruri AH, Naviafar P, Moghiman T. Efficacy of cryotherapy versus intralesional meglumine antimoniate (glucantime) for treatment of cutaneous leishmaniasis in children. Am J Trop Med Hyg 2009; 80(2): 172-5.
  12. Asilian A. Cutaneous Leishmaniasis Diagnosis and Treatment. Isfahan: Isfahan University of Medical Sciences Publications; 1992. P.52.
  13. Momeni A, Aminjavaheri M, Tajdidi M, Emamjomeh M. Effect and side effect of glucantime on leishmaniasis treatment. Pulse Journal 1993; 2: 5-10.
  14. Grevelink SA, Lerner EA. Leishmaniasis. In: Arndt KA, Robinson JK, Leboit PE, Wintroub BU, editors. Cutaneous Medicine and Surgery. Philadelphia: Saunders; 1996. p. 1163-70.
  15. Vega-Lopez F, Hay RJ. Parasitic worms and protozoa. In: Burns T, Breathnach S, Cox N, Griffith's CH, editors. Rook's Textbook of Dermatology. 7th ed. Malden: Wiley-Blackwell; 2004. p. 38-9.
  16. Lupton JR, Alster TS. Laser scar revision. Dermatol Clin 2002; 20(1): 55-65.
  17. Glogau RG, Matarasso SL. Chemical peels. Trichloroacetic acid and phenol. Dermatol Clin 1995; 13(2): 263-76.
  18. Bridenstine JB, Dolezal JF. Standardizing chemical peel solution formulations to avoid mishaps. Great fluctuations in actual concentrations of trichloroacetic acid. J Dermatol Surg Oncol 1994; 20(12): 813-6.
  19. Nilforoushzadeh M, Reiszadeh M, Jaffary F. Comparative effect of tricholoroacetic acid 50% with intralesional glucantime on cutaneous leishmaniasis treatment. Iranian Journal Of Dermatology 2002; 6(22): 34-9.
  20. Levine N. Cutaneous leishmaniasis treated with controlled localized heating. Arch Dermatol 1992; 128(6): 759-61.
  21. Navin TR, Arana BA, Arana FE, de Merida AM, Castillo AL, Pozuelos JL. Placebo-controlled clinical trial of meglumine antimonate (glucantime) vs. localized controlled heat in the treatment of cutaneous leishmaniasis in Guatemala. Am J Trop Med Hyg 1990; 42(1): 43-50.
  22. Manson-Bahr PEC, Bell DR. Manson's Tropical Diseases. 19th ed. Toronto: Ballière Tindall; 1987.
  23. Faghihi G, Tavakoli-kia R. Treatment of cutaneous leishmaniasis with either topical paromomycin or intralesional meglumine antimoniate. Clin Exp Dermatol 2003; 28(1): 13-6.
  24. Nilforoushzadeh MA, Sadeghian G, Jaffary F, Ziaei H, Shirani-Bidabad L, Mahzoni P. Successful treatment of lupoid cutaneous leishmaniasis with glucantime and topical trichloroacetic acid (a case report). Korean J Parasitol 2008; 46(3): 175-7.
  25. Ali NM, Fariba J, Elaheh H, Ali N. The efficacy of 5% trichloroacetic acid cream in the treatment of cutaneous leishmaniasis lesions. J Dermatolog Treat 2010.
  26. Sadeghian G, Nilfroushzadeh MA, Iraji F. Efficacy of local heat therapy by radiofrequency in the treatment of cutaneous leishmaniasis, compared with intralesional injection of meglumine antimoniate. Clin Exp Dermatol 2007; 32(4): 371-4.
  27. Aronson NE, Wortmann GW, Byrne WR, Howard RS, Bernstein WB, Marovich MA, et al. A randomized controlled trial of local heat therapy versus intravenous sodium stibogluconate for the treatment of cutaneous Leishmania major infection. PLoS Negl Trop Dis 2010; 4(3): e628.
Journal of Isfahan Medical School
Volume 29, Issue 161 - Serial Number 161
September and October 2011
Pages 1796-1804

  • Receive Date 17 May 2011
  • Accept Date 06 April 2022