The Efficacy of 5% Trichloroacetic Acid Cream in the Treatment of Cutaneous Leishmaniasis Lesions
DOI:
https://doi.org/10.22100/jkh.v4i4.191Keywords:
Trichloroacetic acid cream, Cutaneous leishmaniasis.Abstract
Introduction: Cutaneous Leishmaniasis (CL) is an endemic parasitic disease in Iran. The residual unpleasant scar of this disease could be a potentially serious psychological threat to the patients. Based on the results of our previous study on the efficacy of trichloroacetic acid (TCA) in the treatment of CL, this study was designed to evaluate the effect of topical 5% TCA cream in the treatment of papulonodular leishmaniasis lesions.
Methods: In this case series study, among the patients who were referred to skin disease and leishmaniasis research center(SDLRC), 16 patients with positive direct smear for leishmaniasis were randomly selected for treatment with 5% TCA cream or, twice a day for 8 weeks or up to complete healing(epithelization)of the lesions. At the end of the treatment period, the response rate was assessed as complete cure, partial cure or treatment failure. The size of the scar was measured 6 months after complete epithelization of the lesions. The data were analyzed using SPSS version 12.
Results: The mean area of the lesions was 38.81± 81.9 mm2 before the treatment, and 3.6± 9.1 mm2 at 6 month follow up period. Complete cure was achieved in 1 patient (6.3%) at week 2, in 13 patients (86.7%) at week 7, and in all patients at week 8. There was no serious reaction in none of the patients. Only one patient had mild erythema at week 2 and edema at the application site at week 5 which completely was resolved within 2 weeks.
Conclusion: Our results showed complete cure in all cases at week 8 without any serious side effects. Considering the efficacy of TCA in decreasing the size of the residual scar and its low cost compared to other treatments, 5% TCA cream could be considered as an alternative modality for intralesional glucantime in the treatment of CL. Further assessment as a double blind randomized clinical trial is warranted.
References
Asilian A. Cutaneous Leishmaniasis. Isfahan University.1992.
Piscopo TV, Mallia Azzopardi C. Leishmaniasis. Postgrad Med J 2007;82(976):649-57.
Desjeux P. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis 2004;27:305-18.
Reithinger R, Dujardin JC, Louzir H, Pirmez C, Alexander B, Brooker S. Cutaneous leishmaniasis. Lancet Infect Dis 2007;7(9):581-96.
Bailey MS, Lockwood DN. Cutaneous leishmaniasis. Clin Dermatol 2007; 25(2):203-11.
Murray HW, Berman JD, Davies CR, Saravia NG. Advances in leishmaniasis. Lancet 2005;366(9496):1561-77.
Minodier P, Parola P. Cutaneous leishmaniasis treatment. Travel Med Infect Dis 2007;5(3):150-8.
Mahajan VK. Sharma NL. Therapeutic options for cutaneous leishmaniasis. J Dermatolog Treat 2007;18(2):97-104.
Khatami A, Firooz A, Gorouhi F, Dowlati Y. Treatment of acute old world cutaneous leishmaniasis: a systematic review of the randomized controlled trials. J Am Acad Dermatol 2007;57(2):335.e1-29.
Minodier P, Noel G, Blanc P, Uters M, Retornaz K, Garnier JM. Management of cutaneous leishmaniasis in adults and children. Med Trop 2005;65(5):487-95.
Matarasso SL, Glogau RG. Chemical face peels. Dermatol Clin 1991; 9:13.
Glogau RG, Matarasso SL. Chemical peels. Trichloroacetic acid and phenol. Dermatol Clin 1995;13(2):263-76.
Bridenstine JB, Dolezal JF. Standardizing chemical peel solution formulations to avoid mishaps. Great fluctuations in actual concentrations of trichloroacetic acid. J Dermatol Surg Oncol 1994;20(12):813-6.
Coleman WP 3rd. Dermal peels. Dermatol Clin 2001;19(3):405-11.
Lawrence N, Cox SE, Cockerell CJ, Freeman RG, Cruz PD. A comparison of the efficacy and safety of jessner's solution and 35% trichloroacetic acid vs 5% fluorouracil in the treatment of widespread facial actinic keratosis. Arch lDermatol 1995;131(2):176-181.
Garrett SJ, Robinson JK, Roenigk HH Jr. Trichloroacetic acid peel of molluscum contagiosum in immunocompromised patients. J Dermatol Surg Oncol 1992;18(10):855-857.
Taner ZM, Taskiran C, Onan AM, Gursoy R, Himmetoglu O. Therapeutic value of trichloroacetic acid in the treatment of isolated genital warts on the external female genitalia. J Reprod Med 2007;52(6):521-5.
Rubin MG. Trichloroacetic acid and other non-phenol peels. Clin Plast Surg 1992;19(2):525-536.
Al-Waiz MM, Al-Sharqi AI. Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals. Dermatol Surg 2002;28(5):383-7.
Yug A, Lane JE, Howard MS, Kent DE. Histologic study of depressed acne scars treated with serial high-concentration (95%) trichloroacetic acid. Dermatol Surg 2006;32(8):985-90.
Effron C, Briden ME, Green BA. Enhancing cosmetic outcomes by combining superficial glycolic acid (alpha- hydroxy acid) peels with nonablative lasers, intense pulsed light, and trichloroacetic acid peels. Cutis 2007;79(1):4-8.
Yamamoto Y, Uede K, Yoni N, Furukawa F. Expression patterns of proliferating cell nuclear antigen in trichloroacetic acid peeled skin. J Dermatol 2007;34(2):95-8.
Zakopoulou N, Kontochristopoulos G. Superficial chemical peels. Journal of cosmetic Dermatology 2006;5(3):246-253.
Nilforoushzadeh MA, Jaffary F, Reiszadeh MR. Comparative effect of topical trichloroacetic asid and intralesional meglumin antimoniate in the treatment of acute cutaneous leishmaniasid. Int J pharmacol 2006;2(6):633-63.[Persian].
Nilforoushzadeh MA, Jaffary F, Derakhshan R, Haftbaradaran E. Comparison of healing effects of local injection of glucantime with or without trichloroacetic acid 50% in cutaneous leishmaniasis. JIMS 2009:27(98):460-7.
Coleman WP. Dermal peels. Dermatol Clin 2001;19(3):405-411.
Cho SB, Park CO, Chung WG, Lee JB, Chung KY. Histometric and histochemical analysis of the effect of trichloroacetic acid concentration in the chemical reconstruction of skin scars method. Dermatol Surg 2006;32(10):1231-6.
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