Efficacy of Fractional wave CO 2 Laser (10600nm) For

Treating Cutaneous Leishmaniasis

Dr. Eshtyag Abdeen Ali Dermatologist

Cutaneous Leishmaniasis

Protozoal disease caused by parasite belonging to the

genus Leishmania transmitted by sand flies sub-type of

phelobotomaniae .

Epidemiology endemic in developing countries. Incidence more than 400,000 cases annually Prevalence ( all forms ) more than 12 million. Although it is frequently seen in the Middle East, Christopherson first reported lupoid Cutaneous Leishmaniasis in the English literature in 1923

Cutaneous Leishmaniasis (CL) is self-healing BUT ??? 3Ds Duration is long (months, sometimes years) Disfiguring scar Destruction of underline structure ( ear, nose)

Treatment:There is no standardized treatment multiple treatments have been reported

with varying degrees of success. Treatment options include: cryotherapy ,topical antimonial

compounds and intra lesional and systemic pentavalent antimony

Recently Carbon-Dioxide laser has been used to vaporize the local lesions with excellent results and satisfactory esthetic outcomes.

In the current study, we evaluated the results of the treatment of Cutaneous Leishmaniasis with fractional-wave CO2 laser.

ObjectivesTo study the efficacy and safety of Carbon

Dioxide Laser in treatment of Cutaneous Leishmaniasis and healing duration.

Material And Methods:  Prospective study 10 cases. This study was carried out in Sudan

University for Science and Technology Conducted between February - September

2014. Diagnosis of Cutaneous Leishmaniasis

was made clinically and confirmed by positive smear for Donvan body.

Inclusion Criteria: Patients of Cutaneous Leishmaniasis

were included regardless of age, sex,

race, social status or occupation. Exclusion Criteria: 1- chronic systemic disease (renal

failure, myocarditis, hepatitis. ) 2- immune suppression 3- pregnancy 4- breast feeding 5- patients receiving other specific

anti leishmanial therapies. 

(between 10-15 Watt fractional wave, duty time 500µs, idle time 0.005s, space o.2mm, graphic circle, diameter depend on the lesion size) was applied to the lesions and an area 2–3 mm around it.

Follow-up evaluation was performed by clinical assessment of treated lesions at weeks 2, 4, 6 and 12.

Results and Discussion

In this study there were 10 patients .Their mean age was 22.5 years

60%

40%

femalemale

Number and Site of Lesions:

The total number of lesions was 1 3

Arm 5 lesions 38.4%

Hand 3 lesions 23.1% Leg 2 lesions

15.4% Forearm 2 lesions 15.4% Foot 1 lesion

07.1%

3

2

8

< 2 cm2-5 cm5 cm or more

Size of lesions

Ulcerated plaque was found in 9 lesions (69.2%), 2 lesions had nodular shape (15.3%) and another 2 lesions had papules shape (15.3%)( table 3.2). .

number morphology

2 (15.3%) papules

2 (15.3)% nodules

9 (69.4%) plaques

Morphology of Lesions:

Duration of Lesions:

Duration per month

Number of Lesions

1 9

2 3

Less than one 1

Outcome of CO2 treatment: First week all patients had dry coagulated film that

formed over the ulcers. One patient his ulcer showed element of

infection treated with topical antibiotics. Two patients had erythema which subsided

within 3-5 days. No patients required analgesia post

procedure

No elements of lymphadenitis in all patients.

One patient with healthy ulcer had smear after one week from the session which came as negative for Donovan body.

The rest of the patients we relayed on clinical parameters for cure.

Second week All coagulated films were fallen, exposing pink granulation tissue. Ulcers were healed, with decrease in diameter about 8-10% in seven lesions and became shallower. Forth week all ulcers healed and covered with thin epithelial layer.

sixth week the ulcers (3) of less than 2 cm healed

without scar

. The ulcers (2) of 2-5 cm healed with scar with 50% reduction in the size .

The ulcers (8) of 5 cm or more the size decreased by 10 %.

23.10%no scar

76.9% scar

Figure (3.4): Healing types

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

Series1

Side effectHypo pigmentation hyper pigmentation

Three patients had hypo pigmentation, six had hyper pigmentation

Picture No (1)

Lesion before treatment

Immediately after laser session

Islands of epithelization after1 week

Before treatment

Healed lesions after 6 weeks

Lesion before treatment

Immediately after laser session

rLesion before treatment

Immediately after laser session

Healed lesions after 6 weeks

Immediately after laser session

Lesion before treatment

Conclusion:The result of this study and others suggest that

Cutaneous Leishmaniasis can be treated effectively with CO2.

Excellent cosmetic out comeShort duration of healingNo evidence of recurrence after treatment by co2

laser.Laser treatment although expensive than other

treatment but can be used as first line therapy for Cutaneous Leishmaniasis (short duration, better outcome and safe)

Thank you