Treatment of cutaneous leishmaniasis with thermotherapy in Brazil: an efficacy and safety study

Abstract

BACKGROUNDPentavalent antimonials remain as the standard drugs in the treatment of cutaneous leishmaniosis. The high cost, difficult administration, long treatment time, toxicity and increasing morbidity are factors that limit the use of these drugs.OBJECTIVESTo describe the response to radiofrequency thermotherapy in the treatment of localized cutaneous leishmaniasis in Brazil, and to evaluate its safety and tolerability.METHODSWe conducted a non-comparative open trial with a total of 15 patients confirmed to have cutaneous leishmaniasis on parasitological examination. A single radiofrequency thermotherapy session at 50ºC for 30 seconds was applied to the lesion and its edges. In patients with more than one lesion, only the largest one was treated initially. If after 30 days there was no evidence of healing, the smaller lesion was also treated with thermotherapy. Clinical cure was defined as visible healing for three months after treatment. The patients were followed-up for six months and there was no follow-up loss.RESULTSOf all 23 lesions, only two evolved to complete healing without the need of treatment. Of 21 lesions, 18 (85.7%) achieved full healing. The main observed side effects were itching, burning sensation, pain and blisters.STUDY LIMITATIONSSample with a small number of patients and short follow-up.CONCLUSIONThermotherapy can be considered a therapeutic alternative in localized cutaneous leishmaniasis, especially in cases of single cutaneous lesions and with formal contraindications to conventional treatment with pentavalent antimonials.

A Review of Leishmaniasis: Current Knowledge and Future Directions

“…Multiple systemic therapies (see Table 3 ) are available including pentavalent antimonials (meglumine antimoniate and sodium stibogluconate), amphotericin (deoxycholate and liposomal formulation), pentamidine and oral therapies (including fluconazole and miltefosine). Pentavalent antimonials are considered standard of care for systemic treatment of CL in Latin America [ 50 ].…”

An overview of the treatment of cutaneous leishmaniasis

“…Thermotherapy can be administered with infrared light, laser, or direct electrical stimulation. Radiofrequency has advantages over other local treatments for Old and New World Leishmaniasis 8 , 9 . One is that radiofrequency waves penetrate uniformly to a depth of 4 mm, so the amastigote can be heated with high temperatures without damaging the surrounding skin, and waves can be applied locally with portable, battery-operated, and localized current fields (ThermoMed).…”

“…This device is safe compared with other traditional treatments and easy to use in rural areas without electricity; however, the thermotherapy machine is expensive. Heat therapy is recommended for lesions caused by any species of Leishmania , and the main side effects are pain, itching, burning sensation, and even second-degree burns 2 , 9 , 10 . It can be used with systemic treatments and is an alternative approach in pregnant women with localized leishmaniasis or patients who have contraindications to systemic therapy 3 .…”

“…The discrepancy between the cure rates may be due to other factors like host immunological response, nutritional status, and different Leishmania spp. 9 , 11 , 12 . It is important to consider that this therapy generates a local thermal dose, so it might not be possible to cure distant lesions, such as in patients with lymph node and mucosal involvement , especially in regions with a high prevalence of mucosal leishmaniasis 9 , 13 .…”

Cutaneous Leishmaniasis: The Complexity of Host’s Effective Immune Response against a Polymorphic Parasitic Disease

“…The species of Leishmania involved in the infection, parasite resistance, and concomitant infections are key factors that influence the efficacy of the treatment [110, 111]. Other treatment possibility is the use of thermotherapy; nevertheless, this technique is not widely available due to the cost of the devices and procedures required and the need of skilled health professionals to perform the treatment [112]. Recent studies about the specific interventions to treat CL in children provide evidences of the scarcity of data available to support treatment recommendations for this age range and of the unmet need to develop and test better treatment options for this vulnerable group [113].…”