Efficacy of cryotherapy for the treatment of cutaneous leishmaniasis: meta-analyses of clinical trials

Abstract

BackgroundCryotherapy is a local treatment for cutaneous leishmaniasis with variable efficacy and greater safety than conventional treatment. The objective of this study is to evaluate the efficacy and safety of cryotherapy for the treatment of cutaneous leishmaniasis and to compare it with pentavalent antimonials.MethodsA meta-analysis based on a search of nine databases with eight strategies was conducted. Inclusion and exclusion criteria were applied, the methodological quality of each article was evaluated, and the reproducibility of the study selection and information extraction from each clinical trial was assured. The per lesion and per patient efficacy was calculated, and a meta-analysis of relative risks with the random effects model and the Dersimonian and Laird's, Begg, and Egger tests, along with a sensitivity analysis, were performed. A meta-regression based on the methodological quality of the trials included was also performed.ResultsEight studies were included in which respective per lesion efficacies of 67.3 % and 67.7 % were reported for cryotherapy and pentavalent antimonials. In 271 patients treated with cryotherapy and in 199 with pentavalent antimonials, respective per protocol and intent to treat efficacies of 63.6 % and 54.2 % were found in the first group, and per protocol and intent to treat efficacies of 74.7 % and 68.3 % were found in the second group. The relative risk for the comparison of efficacy in the two groups was 0.73 (0.42–1.29). The results of the sensitivity analysis and the meta-regression analysis of relative risks were statistically equal to the overall results.ConclusionThis investigation provides evidence in favor of the use of cryotherapy given that its efficacy is similar to that of pentavalent antimonials.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1663-3) contains supplementary material, which is available to authorized users.

Clinical Presentation of Cutaneous Leishmaniasis caused by <b><i>Leishmania major</i></b>

“…Nevertheless, due to their adverse effects such as myalgia, arthralgia, renal failure, leukopenia, anemia, thrombocytopenia, and cardiotoxicity [23,24] , other local alternatives have been implemented. Currently, cryotherapy is increasingly used for the treatment of cutaneous leishmaniasis, demonstrating a similar efficacy with the pentavalent antimony [25] . Another kind of treatment is currently available involving the application of heat, thermotherapy, demonstrating a greater safety and lower cost, especially in the case of contraindications to systemic treatment [26] .…”

Cryosurgery in a dermatology setup: a hospital based study

“…In a randomized clinical trial, Farajzadeh found that cryotherapy in combination with oral terbinafine was less effective then cryotherapy with systemic Meglumine Antimoniate. In a meta-analysis, per lesion efficacy of 67.3% and 67.7% were reported for cryotherapy and pentavalent antimonials respectively [15]. In a case series for multiple recurrent Actinic keratosis sequential treatment of diclofenac 3% gel with cryotherapy was found to be an effective treatment [16].…”

Natural Compounds and Extracts from Mexican Medicinal Plants with Anti-Leishmanial Activity: An Update

“…Both therapies are used in Mexico and in some regions worldwide [22]. Antibacterials as penicillin or antifungal creams (such as miconazole, ketoconazole, or itraconazole) are applied on the lesion [40]. Mexican patients have also used acetic acid, boric acid, sulfuric acid (car battery acid), formalin, alcohol, hydrogen peroxide, wire and copper sulfate, among other remedies [22,42].…”