Comparing the Efficacy of Oral Chloroquine versus Oral Tetracycline in the Treatment of Cutaneous Leishmaniasis.

OBJECTIVE: To compare the efficacy of oral chloroquine versus oral tetracycline in the treatment of cutaneous leishmaniasis (CL). STUDY DESIGN: Interventional comparative study. PLACE AND DURATION OF STUDY: Department of Dermatology, Sheikh Zayed Hospital, Rahim Yar Khan, from July 2017 to January 2018. METHODOLOGY: Cases of CL with age 12 years or above were included. The diagnosis of cutaneous leishmaniasis was made on the basis of history of travel to rural endemic area and clinical features of non-healing ulcer and on detection of Amastigotes on Giemsa staining on smear taken from the involved site. A total of 50 patients were selected randomly. They were divided into two groups. Group A was treated with chloroquine in a dose of 250 mg twice daily per oral (10 mg/kg/day) and Group B was treated with doxycycline in a dose of 200 mg daily per oral (3.3 mg/kg/day). They were followed up for three months. Efficacy was labelled as 'yes' where there was complete re-epithelisation or healing with or without scarring of the lesions with no induration. RESULTS: There were a total of 50 cases, 25 were in each group. The mean age in group A and B was 30.56 ±7.14 and 27.96 ±6.97, respectively with p=0.199. All the cases belonged to rural population and were from endemic areas. There was no difference in terms of site of lesion. Upper limbs were the most common in both groups with p=0.34. The efficacy in group A was 100% while in group B it was 23 (92%) of cases with p=0.14. CONCLUSION: Oral tetracycline is as efficacious as oral chloroquin in the treatment of cutaneous leishmaniasis.

Combination of Oral Tranexamic Acid with Topical 3% Tranexamic Acid versus Oral Tranexamic Acid with Topical 20% Azelaic Acid in the Treatment of Melasma.

OBJECTIVE: To compare the effect of combination therapies of topical 3% tranexamic acid versus topical 20% azelaic acid each combined with oral tranexamic acid in the treatment of melasma. STUDY DESIGN: Interventional comparative study. PLACE AND DURATION OF STUDY: Department of Dermatology, Sheikh Zayed Hospital, Rahim Yar Khan, from July 2017 to June 2018. METHODOLOGY: Cases of melasma diagnosed clinically (based upon history and the clinical findings of symmetrically distributed hyperpigmented macules and patches on the face), aged 12 to 50 years, were selected. The cases were divided into two groups by simple random sampling method. The cases in group A were treated by oral tranexamic acid (250 mg twice daily) with topical 3% tranexamic acid (twice daily). In group B, cases had oral tranexamic acid (250 mg twice daily) with topical 20% azelaic acid (daily) for six months. They were followed every second month upto 6 months and the efficacy was assessed on the basis of scores on MASI scale. RESULTS: In 100 patient, there was no significant difference in terms of mean MASI score at 2 and 4 months with p-value of 0.20 and 0.89, respectively. However, mean MASI score was significantly less in group A (6.06 ±5.06 vs. 10.62 ±7.43) in group B (p=0.001). In group A, 14 (28%) had excellent response, whereas in group B, 11 (22%) had excellent results. CONCLUSION: Combination of oral and topical 3% tranexamic acid is significantly better than oral tranexamic acid with 20% azelaic acid for treatment of melasma.

Intralesional Versus Oral Chloroquine in Cutaneous Leishmaniasis: Comparison of Outcome, Duration of Treatment and Total Dose of Drug.

OBJECTIVE: To compare intralesional versus oral chloroquine in cutaneous leishmaniasis and determine the cure rate, duration of treatment, and total dose of drug. STUDY DESIGN: Randomized controlled study. PLACE AND DURATION OF STUDY: Department of Dermatology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from November 2013 to June 2014. METHODOLOGY: Consecutive 86 patients of cutaneous leishmaniasis, with single to multiple lesions of various sizes were enrolled and divided randomly into group Aand B for the purpose of intralesional and oral chloroquine administration, respectively to compare the effect of the two routes on duration of treatment and total dose of the drug. SPSS version 16 was used for data analysis after data entry into it. Quantitative variables like, duration, cost and total dose of treatment were calculated as mean and standard deviation and compared by using T-test. P-value of less than 0.05 was taken as significant. RESULTS: Cure rate was 100% in both groups towards the end of treatment. Mean duration of treatment was 9.17 ±3 weeks in intralesional (A) group as against 11.37 ±3 weeks in oral (B) group (p = 0.0028). Mean total dose of the drug given to each patient in group Awas 5.8 ±0.5 gm and in group B, it was 19.2 ±1.5 gm, which is significantly higher (p < 0.001). The total cost of treatment in group Awas Rs. 90 ±8 and in group B it was Rs. 91 ±1 (p=0.446). CONCLUSION: Duration of treatment is significantly shorter and total dose is lesser with intralesional compared to oral chloroquine in treatment of cutaneous leishmaniasis.