Abstract:
Objective To determine the efficacy of triple therapy using oral ketoconazole and oral zinc sulfate plus topical podophyllin in the management of cutaneous leishmaniasis. Methods This is a prospective, therapeutic study that was performed during the period, March 2019 to December 2021 where 230 patients with acute and chronic cutaneous leishmaniasis were recruited in this work. Smear and histopathology were used to confirm the diagnosis. All cases were treated by oral zinc sulfate (5-10 mg/kg/day in divided doses) while oral ketoconazole was given 200mg twice a day for adults and 100mg for young children and 50-75 mg a day for infants according to the body weight (3.3-6.6 mg/kg/day). Topical 25% podophyllin solution was applied once a week. The duration of therapy was continued up to 6 weeks to be seen every two weeks until complete cure, then followed every month for the next three months .To assess response to treatment, Sharquie's modified Leishmania scoring was applied. Results The analysis of 230 patients with cutaneous leishmaniasis showed the age of presenting patients ranged from 6months-60years. The mean of age was 27 years with 120 (52.17%) males and110 (47.82 %) females. All patients mentioned that response was started after a week but on examination, was obvious after two weeks and complete clearance after 6 weeks. After completion of the treatment, the cure rate was 99%. No important adverse effects were noticed in any patients but gastric irritation was seen in some patients receiving zinc sulfate and skin burning in some patients using podophyllin. Conclusion Triple therapy of cutaneous leishmaniasis using oral ketoconazole, oral zinc sulfate plus topical podophyllin was effective in treatment of acute and chronic leishmaniasis although every single therapy is effective but aiming to increase the effectiveness especially in chronic cases and to avoid failure of treatment. No important systemic and local adverse reactions were recorded.
Page(s):
502-509
DOI:
DOI not available
Published:
Journal: Journal of Pakistan Association of Dermatologists, Volume: 32, Issue: 3, Year: 2022
Keywords:
Ketoconazole
,
Cutaneous leishmaniasis
,
Zinc sulfate
,
podophyllin