Abstract
The incidence of cutaneous leishmaniasis has shown a resurgence in recent years in Tunisia. Because of the toxicity and high cost of pentivalent antimonials we have sought alternative medications. In a study of 14 patients with cutaneous leishmaniasis, ten patients acheived complete clinical regression of the lesions with oral administration of doxycycline, 200mg per day, for 15-30 days.
Introduction
Tunisia has been living through a renewed outbreak of cutaneous leishmaniasis (CL) for several years. The reference treatment is based on pentavalent antimonium. However, its high cost and secondary effects have led to research into other therapeutic alternatives such as the cyclines [1].
The aim of this study was to evaluate the efficacy of the doxycycline in the treatment of cutaneous leishmaniasis.
Patients and methods
Our study was prospective. A treatment by doxycycline was proposed for 30 patients (16 and older) from the center and south of Tunisia (endemic zones of Leishmania major) who presented with CL. We were able to follow only 14 patients. The diagnosis of CL was confirmed by dermic smears or polymerase chain reaction (PCR). The criteria of inclusion were a non-treated CL with the absence of contraindications in the cyclines. Every patient was treated by oral doxycyline at a dose of 200mg per day for a period of 15 to 30 days. A weekly control for the size of lesions was realized (diameter of infiltration). The period of control was 45 days.
Results
The patients that were followed were 5 men and 9 women (sex ratio = 0.44) with an average age of 43.9 years (the age extremes varied from 23 to 75 years). The mean number of the lesions was 5.2 lesions per patient. The duration of the evolution of the cutaneous lesions before taking the treatment varied from 10 to 70 days with an average duration of 38 days. An ulcero-crusted form was present in 10 patients. Nodular, sporotrichoid, erysipeloid, and lupoid forms were present in one patient each.
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| Figure 1 | Figure 2 |
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| Figure 1. Desinfiltration of lesions. The duration of treatment was 30 days. | |
A complete desinfiltration (Fig. 1) of the lesions was found for 10 patients (71%) (Table 1). The average duration of the treatment was 22.5 days. No secondary effects were detected.
Commentary
According to our study, the cyclines seem to be efficient in the treatment of cutaneous leishmaniasis. In fact, with an efficacy rate of 71 percent, the doxycycline is comparable with the pentavalent antimony which presented an efficacy rate from to 60 to 90 percent [2].
Although the mechanism of action of pentavalent antimony is well known (inhibition of adenosine triphosphate synthetase of the parasite [3]), that of doxycycline is still discussed. Many hypotheses can explain the mode of action of the cyclines in CL:
- Direct activity on the body of leishmania with analogy to an anti-bacterial activity thanks to good intracellular penetration [4].
- The cyclines have an anti-inflammatory activity that explain in part its indication in many cutaneous affections especially granomomatous dermatosis (rosacea) [5]. Remember that organized or non-organized granuloma can be observed in CL.
- The cyclines constitute one of the therapeutic alternatives in CL always out of AMM. Some authors have studied its benefits in CL [6, 7, 8], Khairulin et al. [8] have effectively treated 69 patients having CL with metacycline and 60 patients with doxycycline.
- Doxycycline rarely has any secondary effects in a short period treatment. They can be digestive intolerance, phototoxicity, rarely cutaneous eruption, or hematologic affection [4, 9]. In our study, none of these was detected.
Conclusion
Doxycycline can constitute therapeutic alternative in cutaneous leishmaniasis, particularly in the endemic zones, offering a better tolerance and a lower cost. A controlled study should be realized to confirm the efficacy of this treatment.
References
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