The effect of intralesional meglumine antimoniate (glucantime) versus a combination of topical trichloroacetic acid 50% and local heat therapy by non-ablative radiofrequency on cutaneous leishmaniasis lesions

BACKGROUND: Pentavalent antimonial drugs have been the first line of therapy in cutaneous leishmaniasis for many years. However the cure rate of these agents is still not favorable. This study was carried out to compare the effect of 50% topical trichloroacetic acid in combination with non-ablative radiofrequency heat therapy and intralesional glucantime on cutaneous leishmaniasis. METHODS: A total of 76 lesions in 60 patients were studied and randomly divided into 2 groups. A total of 30 patients with 38 lesions were treated with intralesional injection of meglumine antimoniate (Glucantime) (Sanofi-Aventis, France) as group-1 and the 38 lesions in the remaining 30 patients were treated with a combination of non-ablative radiofrequency and 50% topical trichloroacetic acid as group-2. Complete cure rate besides the lesion's changes in size and size of scars were assessed and compared between groups especially according to gender and location of initial lesions. RESULTS: complete cure of after 4 months of treatment was achieved significantly more in group-1 than group-2 (p = 0.01). However, the complete cure rate at month 6 of treatment was not significantly different between groups (p = 0.06). Score II-III of the lesions' reduction size (more than 50% reduction in size) was achieved significantly more in group-1 (p = 0.004). There was no significant cure rate difference between the two groups according to the location of lesions (head and upper extremities vs. lower extremities) or the patient's sex. Moreover, there was no significant scar size difference between groups according to the location of lesions. CONCLUSIONS: The study showed that intralesional glucantime has a significantly higher cure rate of cutaneous leishmaniasis in a shorter time than 50% trichloroacetic acid in combination with non-ablative radiofrequency. Furthermore, it could significantly induced efficient reduction size of more than 50% in most lesions. The analysis reveals that intralesional glucantime still has the superiority to be the first line of therapy in cutaneous leishmaniasis.