Laser combination therapy shows promise for cutaneous leishmaniasis treatment

Combining ablative fractional laser resurfacing with laser-assisted delivery of a topical antibiotic treats cutaneous leishmaniasis effectively.

In a pilot study, researchers at the University of California San Diego School of Medicine (San Diego, CA) and colleagues investigated the effectiveness of a laser therapy approach combining ablative fractional laser resurfacing with laser-assisted delivery of topical paromomycin (an antibiotic) to treat cutaneous leishmaniasis, a skin infection caused by a single-celled parasite that is transmitted by the bite of a phlebotomine sandfly.

Leishmaniasis can cause manifestations that range from localized skin ulceration to lethal visceral disease. Despite an estimated 2 million cases annually because of increased international travel (particularly cutaneous leishmaniasis), current treatment options are still limited. Ablative fractional laser resurfacing represents a treatment option and may address challenges commonly encountered in cutaneous leishmaniasis treatment.

In the research team's pilot study, skin biopsy on an adolescent female with several non-tender, non-healing wounds on her bilateral upper and lower extremities after camping overnight in the Negev Desert (Israel) strongly suggested the diagnosis of cutaneous leishmaniasis. Polymerase chain reaction (PCR) testing by the Centers for Disease Control and Prevention confirmed infection by Leishmania major.

A six-week course of oral fluconazole in conjunction with topical paromomycin healed all but the young woman's largest wound located on her left medial lower leg, explains Andrew C. Krakowski, MD, of the Division of Pediatric and Adolescent Dermatology at Rady Children's Hospital (San Diego) and the University of California San Diego School of Medicine, a corresponding author of the study. This recalcitrant lesion was subsequently treated with an ablative microfractionated 10,600-nm carbon dioxide laser (Lumenis; Yokneam, Israel) and topical paromomycin applied immediately after laser surgery (i.e., laser-assisted delivery) and continued daily for a total of three months. Her infection resolved, and the lesion healed with minimal scarring in this sensitive anatomic location.

“The results of this single, unblinded study suggest this novel combination therapy may offer promise as a new treatment modality for cutaneous leishmaniasis infection while helping to accelerate wound healing and mitigate scarring,” Krakowski adds.

Full details of the work appear in the journal Lasers in Surgery and Medicine; for more information, please visit http://dx.doi.org/10.1002/lsm.22426.

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