Topical Therapy of Acute Cutaneous Leishmaniasis Using Zinc Sulphate Solution 25% versus Podophyllin Solution 25%

Abstract

Background : Zinc sulphate as intralesional and oral therapy was used as a successful therapy in treatment of cutaneous leishmaniasis while 25% topical podophyllin is now commonly used in the treatment of cutaneous leishmaniasis. Objective : To treat acute cutaneous leishmaniasis using topical zinc sulphate solution 25% to be compared with topical podophyllin solution 25%. Patients and Methods : This is a single, blind, interventional, comparative study done in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from January 2015 to June 2015. Forty patients with a total 88 lesions of acute cutaneous leishmaniasis were enrolled in this study; 54 (61.36%) were dry lesions and 34 (38.6%) were ulcerative type. The duration of lesions ranged from 2 - 11 (7.7 + 2.483) weeks. The size of the lesions ranged from 0.3 to 8 (2.13 ± 1.53) cm. There were 21 females and 19 males, female to male ratio (1.1:1) and their ages ranged from 1 to 60 (25.92 ± 16.59) years. Diagnosis was confirmed by tissue smear and histopathology. Lesions were divided into two groups with matching types and sizes, and scored according to Sharquie modified Leishmania score to assess the objective response to the topical or systemic therapy and then during follow up responses were graded into mild, moderate, marked response and complete clearance. Group A treated with topical 25% podophyllin solution once weekly for a maximum of 6 weeks, while group B was treated with topical 25% zinc sulphate solution twice daily for 6 weeks. Follow up was every 2 weeks during therapy, and once monthly for 3 months after therapy. Results : A total of 40 patients with clinical diagnosis of acute cutaneous leishmaniasis were included in this study, with a total of 88 lesions. Fifteen (37.50%) patients had single lesion and 25 (62.50%) patients had multiple lesions. Family history of CL was positive in 42.5% of patients. At the end of six weeks after starting therapy, the total cure rate in patients treated by topical podophyllin ( both marked and complete responses ) was seen in 32 (82%) lesions, while the cure rate in patients treated by topical zinc sulphate was in 36 (73.4%) lesions. There was no statistical significant difference between the cure rates of both groups. No important local or systemic side effects were seen in any patients. Conclusion : Topical zinc sulphate 25% is an effective simple non-invasive non-costly safe topical therapy for cutaneous leishmaniasis and without any contraindications for its use and free of side effects and was as effective as topical podophyllin .