Fractional Ablative CO2 Laser Followed by Topical Application of Sodium Stibogluconate for Treatment of Active Cutaneous Leishmaniasis: A Randomized Controlled Trial
Ofir Artzi, Eli Sprecher, Amir Koren, Joseph N. Mehrabi, Oren Katz, Yuval Hilerowich
Conventional treatment of cutaneous leishmaniasis often leaves permanent scars with frequent psychosocial sequelae. The aim of this study was to compare the efficacy, safety, associated pain and final cosmetic outcome of fractional carbon dioxide (CO2) laser followed by topical application of sodium stibogluconate vs. sodium stibogluconate injections for the treatment of cutaneous leishmaniasis. A total of 181 lesions (20 patients) were randomly assigned to receive intralesional injections of sodium stibogluconate (control group) or fractional CO2 laser treatment followed by topical application of sodium stibogluconate (study group). The visual analogue scale (VAS) score of the control group was much higher than that of the study group (6.85 vs. 3.5, respectively, p < 0.001). Both the patients and 2 blinded dermatologists found the final cosmetic outcome to be superior for laser-treated lesions (p = 0.001 vs. p =0.008 for controls). Fractional CO2 laser treatment followed by topical application of sodium stibogluconate is less painful and leads to a better final cosmetic outcome compared with intralesional injections of sodium stibogluconate.
Cutaneous leishmaniasis is a parasitic infection that affects millions of people every year (1). Although common treatments vary in safety and efficacy, none of them addresses the disfiguring atrophic hypo- or hyper-pigmented post-inflammatory scars. The current study shows that fractional carbon dioxide (CO2) laser treatment, followed by topical application of sodium stibogluconate, is an effective, safe treatment, which is less painful and results in better final cosmesis compared with the current gold standard, intralesional injections of sodium stibogluconate.