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OBJETIVO: Analisar os efeitos do laser de baixa potência na intervenção às lesões decorrentes da Leishmaniose Cutânea. MÉTODO: Trata-se de um estudo quase-experimental, duplo-cego e randomizado realizado em um centro de referência do Norte de Minas Gerais. Foram alocados aleatoriamente 07 pacientes que foram submetidos ao tratamento endovenoso e curativos locais da leishmaniose cutânea, a saber: 03 no grupo controle, onde fizeram uso do tratamento convencional, e 04 no grupo experimental, que foram submetidos a aplicação da laserterapia de baixa potência, além da terapêutica habitual. Foi avaliado como desfecho primário a redução do tamanho das lesões, por meio da adaptação da ferramenta Pressure Ulcer Scale for Healing. A análise dos dados foi conduzida por meio de uma estatística comparativa pareada com teste T. RESULTADOS: Não houve diferença significativa entre os grupos controle e experimental. CONCLUSÃO: A laserterapia de baixa potência não parece favorecer a cicatrização das lesões por leishmaniose cutânea.

OBJECTIVE: To analyze the effects of low-level laser therapy in treating lesions resulting from cutaneous leishmaniasis. METHODS: This is a double-blind, randomized, quasi-experimental study conducted at a reference center in the northern region of Minas Gerais. Seven patients were randomly assigned to receive intravenous and local wound care for cutaneous leishmaniasis. Specifically, three patients were assigned to the control group and received conventional treatment, while four patients were assigned to the experimental group and received low-level laser therapy plus standard therapeutic measures. The primary outcome measure was the reduction in lesion size as assessed by the adapted Pressure Ulcer Scale for Healing. Paired comparison statistics using the t-test were used for data analysis. RESULTS: No significant difference was observed between the control and experimental groups. CONCLUSION: Low-level laser therapy does not appear to improve the healing of cutaneous leishmaniasis lesions.

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BACKGROUND: Treatment of cutaneous leishmaniasis remains a challenge; new physical treatment modalities including laser systems are of interest in the treatment of localized lesions. METHOD: Fourteen patients (10 females) with 20 lesions of Old World cutaneous leishmaniasis underwent weekly treatments of 1540 nm erbium glass fractional laser (Palomar) using 10 mm spot size hand piece in four passes of 50-70 mJ/cm2 fluence and 10 ms pulse duration. RESULTS: Twelve lesions were available for assessment: six (50%) improved at 6 weeks and eleven lesions (91.7%) at 12 weeks. There were no recurrences at 6- and 12-month follow-ups. CONCLUSION: Erbium glass fractional laser may be an alternative treatment for localized cases of Old World cutaneous leishmaniasis.

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BACKGROUND AND OBJECTIVE: Cutaneous leishmaniasis is a prevalent skin condition especially in the Middle Eastern region. The use of pulsed dye laser (PDL) for the treatment of cutaneous leishmaniasis (CL) has not been thoroughly evaluated. We assessed primarily the efficacy of 595-nm PDL in the treatment of CL lesions and interpreted its impact on the quality of life (QOL) of affected patients as measured by the Dermatology Life Quality Index (DLQI). PATIENTS AND METHODS: Twenty-five lesions from 12 patients were treated with a single pass of PDL over the whole lesions to develop a purpuric end point. Parameters used for this treatment were 7 J/cm2 fluence, 10-mm spot size, and 0.45-ms pulse duration. The laser settings were maintained in all subsequent treatments. RESULTS: Excellent response was noted in 13 of the 25 lesions after 3 sessions, while 12 of the remaining 25 lesions required 4 sessions toward complete recovery. The mean DLQI scores pre- and post-laser treatments were 12.67 and 4.25, respectively. All patients experienced a statistically significant improvement in their QOL (p < 0.05, paired t-test). CONCLUSION: The PDL is a new safe modality for treating cases of CL with further larger-scale studies could better determine its role.

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BACKGROUND AND OBJECTIVE: The pulsed dye laser (PDL) is not tested yet for the treatment of cutaneous leishmaniasis (CL). We compared the efficacy of 585 nm PDL with intralesional meglumine antimoniate (MA) on 17 patients with 81 lesions of CL. PATIENTS AND METHODS: Out of the 81 lesions, 42 lesions were treated with one or two passes of PDL fortnightly and 39 lesions in the same patients were treated with intralesional MA weekly. The fluence chosen for the laser was 7 Joules/cm² with 5 mm spot size. The MA treated lesions were infiltrated gently with MA to blanch the lesions completely. RESULTS: All laser treated lesions were responded well with almost 66.7% cure after the first, and more than 90% after the second treatment. One patient was recovered after third, and the last one after fourth sessions. All 39 MA treated lesions were also responded after third to eighth sessions. The mean number of the sessions required for the patients to be treated with PDL is 1.85, and the mean number of the sessions required for the patients to be treated with MA is 4.6. CONCLUSIONS: The PDL can cure many cases of CL particularly in their early stages faster than MA.

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Cutaneous leishmaniasis (CL) is endemic in the Bikaner region situated in the Thar Desert of Rajasthan, India. This study describes clinicoepidemiological data of pediatric CL in pre-school children (0-5 years of age) from this region during 2001-2012. In total, 151 patients with 217 lesions were reported during the study period. The mean age of the study group was 3.29 ± 1.43 years (0.25-5 years), with many (41.7%) cases being in the age group of 2-4 years. Face was the most common site involved, and morphologically, the lesions were either plaque type or papulonodular. Smear for parasitologic examination was positive in 84 (70%) of 120 cases, and histopathologic examination confirmed CL in 10 (55.55%) of 18 cases. Parasite species identification conducted for 13 randomly selected patients by polymerase chain reaction identified Leishmania tropica as the causative species. Intralesional sodium stibogluconate was the most commonly used treatment and found to be well-tolerated. Other therapies that were effective included oral rifampicin, oral dapsone, radiofrequency heat therapy (RFHT), and combinations of the three therapies.

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BACKGROUND: Pentavalent antimony is the agent recommended for treatment of cutaneous leishmaniasis (CL). Its use is problematic, because it is expensive and because of the potential for drug-associated adverse effects during a lengthy and painful treatment course. METHODS: We tested the efficacy of thermotherapy for the treatment of CL due to Leishmania tropica in a randomized, controlled trial in Kabul, Afghanistan. We enrolled 401 patients with a single CL lesion and administered thermotherapy using radio-frequency waves (1 treatment of >or=1 consecutive application at 50 degrees C for 30 s) or sodium stibogluconate (SSG), administered either intralesionally (a total of 5 injections of 2-5 mL every 5-7 days, depending on lesion size) or intramuscularly (20 mg/kg daily for 21 days). RESULTS: Cure, defined as complete reepithelialization at 100 days after treatment initiation, was observed in 75 (69.4%) of 108 patients who received thermotherapy, 70 (75.3%) of 93 patients who received intralesional SSG, and 26 (44.8%) of 58 patients who received intramuscular SSG. The OR for cure with thermotherapy was 2.80 (95% confidence interval [CI], 1.45-5.41), compared with intramuscular SSG treatment (P=.002). No statistically significant difference was observed in the odds of cure in comparison of intralesional SSG and thermotherapy treatments. The OR for cure with intralesional SSG treatment was 3.75 (95% CI, 1.86-7.54), compared with intramuscular SSG treatment (P<.001). The time to cure was significantly shorter in the thermotherapy group (median, 53 days) than in the intralesional SSG or intramuscularly SSG group (median, 75 days and >100 days, respectively; P=.003). CONCLUSIONS: Thermotherapy is an effective, comparatively well-tolerated, and rapid treatment for CL, and it should be considered as an alternative to antimony treatment.

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This study investigated the mechanism of action and efficacy of CO2 laser rays and hypertonic sodium chloride (NaCl) with different concentrations in treatment of cutaneous leishmaniasis (CL) as assessed clinically, parasitologically, histopathologically by light & transmission electron microscopy (TEM) and immunologically by RT-PCR for gene expression of interleukin-13 (IL-13). Eighty mice were divided into four groups. The first was non infected control group (n=16) and the second was infected and served as non-treated control (n=16). The third (n=32) and fourth groups (n=16) were subjected to NaCl injection and CO2 laser respectively. Results showed that clinical healing by CO2 laser were nearly similar to normal appearance, but differed according to concentration of NaCl, as confirmed by ultrastructure and immunohistopathologic features of the host cells and surrounding skin tissue. IL-13 mRNA was significantly decreased after treatment denoting that Th2 cytokine (IL-13) is important for the development of strategies to prevent the induction of pathologic processes. It is concluded that CO2 laser then 7% NaCl are good modalities for CL treatment and is recommended wherever possible.

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In order to study the role of natural killer (NK) cells during the early period of Leishmania infection, BALB/c mice were selectively and permanently depleted of NK cells by injection with 90Sr and subsequently infected with Leishmania (Leishmania) amazonensis (HSJD-1 strain). 90Sr is known to selectively deplete NK cells, leaving an intact T- and B-cell compartment and preserving the ability to produce both interferon alpha and IL-2. This method of depletion has advantages when compared with depletion using anti-NK cell monoclonal antibodies because the effect is permanent and neither activates complement nor provokes massive cell death. In the present study, after one month of treatment with 90Sr, the depletion of NK cells was shown by a more than ten-fold reduction in the cytotoxic activity of these cells: 2 x 10(6) spleen cells from NK-depleted animals were required to reach the same specific lysis of target cells effected by 0.15 x 10(6) spleen cells from normal control animals. The histopathology of the skin lesion at 7 days after Leishmania infection showed more parasites in the NK cell-depleted group. This observation further strengthens a direct role of NK cells during the early period of Leishmania infection.

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In order to study the role of natural killer (NK) cells during the early period of Leishmania infection, BALB/c mice were selectively and permanently depleted of NK cells by injection with 90Sr and subsequently infected with Leishmania (Leishmania) amazonensis (HSJD-1 strain). 90Sr is known to selectively deplete NK cells, leaving an intact T- and B-cell compartment and preserving the ability to produce both interferon alpha and IL-2. This method of depletion has advantages when compared with depletion using anti-NK cell monoclonal antibodies because the effect is permanent and neither activates complement nor provokes massive cell death. In the present study, after one month of treatment with 90Sr, the depletion of NK cells was shown by a more than ten-fold reduction in the cytotoxic activity of these cells: 2 x 106 spleen cells from NK-depleted animals were required to reach the same specific lysis of target cells effected by 0.15 x 106 spleen cells from normal control animals. The histopathology of the skin lesion at 7 days after Leishmania infection showed more parasites in the NK cell-depleted group. This observation further strengthens a direct role of NK cells during the early period of Leishmania infection

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