Summary:
Introduction: The incidence of cutaneous leishmaniasis has been for years
globally underestimated. However, 1.5 million new cases occur each year in
endemic areas.It is also a public health problem in Europe. The pentavalent
antimonials are considered the golden standard for treatment of leishmaniasis.
Nevertheless, resistant species of Leishmania and significant adverse effects
have appeared , leading to search of new , more effective treatment modalities
with less adverse effects.
Aim: Conduct of a systematic literature review on the new data on cutaneous
leishmaniasis treatment during the last three years( 2009-2012).
Materials and Methods: Electronic online databases Pubmed, MEDLINE, LILACS,
Scielo, Scopus and the Cochrane Central Register of Controlled Trials were
searched from January 2009 until April 2012 to identify articles related to
cutaneous leishmaniasis and therapy . The search terms were «cutaneous
leishmaniasis treatment», «pentavalent antimony», «meglumine»
«stibogluconate»,, «glucantime», «paromomycin». Articles with adequate data on
cure and treatment failure, internal and external validity information were
included.
Results: We found 5427 articles. 15 randomized controlled trials were
eventually selected for the systematic review. Miltefosine p.o., a
phosphoholine analog , was more effective than parenteral pentavalent antimony
in cutaneous leishmaniasis treatment. Fluconazole 400mg p.o was also effective.
A new vaccine , LEISH-F1+ MPL-SE , seems to be effective both in treatment and
prevention of the disease. Patch NO was studied and low cure rates occurred.
Nevertheless, its advantage was the low rate of adverse effects. Imiquimod,
paromomycin , laser CO2 , cryotherapy , topical heat and intralesional
pentavalent antimony with mesotherapy are therapeutic modalities with high cure
rates, few adverse effects and promising results.
Conclusion: Cutaneous leishmaniasis is a disease of major importance and
concern both in developing and developed world , mainly due to increase in
global tourism. Although pentavalent antimonials are the drugs of choice in the
treatment of CL, new therapeutic modalities, especially those emphasizing in
topical treatment , have shown equivalent effectiveness with less adverse
effects. Nevertheless, several aspects, such as cost, adverse effects, local
experience, and availability of drugs to treat cutaneous leishmaniasis, must be
considered when determining the best management of this disease.
Keywords:
cutaneous leishmaniasis treatment, pentavalent antimony, meglumine, glucantime, stibogluconate
