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Can a simple outpatient-based treatment be used to treat cutaneous leishmaniasis in young children? A critically appraised topic

Burden-Teh, E.; Wooton, C.I.; Williams, H.C.

Authors

C.I. Wooton

Profile image of HYWEL WILLIAMS

HYWEL WILLIAMS HYWEL.WILLIAMS@NOTTINGHAM.AC.UK
Professor of Dermato-Epidemiology



Abstract

A 5‐year‐old boy from rural Afghanistan presented with a 1‐year history of a skin lesion on his left knee, confirmed by polymerase chain reaction to be cutaneous leishmaniasis (Leishmania tropica). Conventional treatment of cutaneous leishmaniasis involves intravenous or intralesional pentavalent antimonials. The aim of this Critically Appraised Topic (CAT) is therefore to determine what alternative effective but less painful treatments (such as oral or topical therapies) can be used to treat cutaneous leishmaniasis in children. Embase and PubMed were searched for ‘cutaneous leishmania*’ AND ‘treatment’ AND ‘children’ in August 2014. All abstracts from April 2008 to August 2014 were reviewed. This search period was chosen to follow on from the Cochrane reviews on Old World and American leishmaniasis. Five randomized controlled trials met our inclusion criteria and have been included in this CAT. The study design and reporting quality in most of the trials included in both Cochrane reviews was found to be poor, and neither Cochrane review investigated the effect of patient age on response to treatment. This CAT identified two nonpainful treatments, topical paromomycin and oral miltefosine, whose effective use in children is supported in the literature. However, both of these treatments are currently unlicensed in the U.K. Our patient was successfully treated with miltefosine 20 mg twice daily for 4 weeks, leading to good resolution of the leishmaniasis plaque but with residual scarring.

Citation

Burden-Teh, E., Wooton, C., & Williams, H. (2015). Can a simple outpatient-based treatment be used to treat cutaneous leishmaniasis in young children? A critically appraised topic. British Journal of Dermatology, 172(4), 861-866. https://doi.org/10.1111/bjd.13496

Journal Article Type Article
Acceptance Date Oct 20, 2014
Online Publication Date Oct 29, 2014
Publication Date Apr 1, 2015
Deposit Date Aug 8, 2018
Print ISSN 0007-0963
Electronic ISSN 1365-2133
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 172
Issue 4
Pages 861-866
DOI https://doi.org/10.1111/bjd.13496
Public URL https://nottingham-repository.worktribe.com/output/1111530
Publisher URL https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.13496
Related Public URLs http://www.ncbi.nlm.nih.gov/pubmed/25354137