Advances in the treatment of cutaneous leishmaniasis in the new world in the last ten years: a systematic literature review.

INTRODUCTION: The therapeutic arsenal against cutaneous leishmaniasis is very limited. Pentavalent antimonial compounds have been the drugs of choice for treatment of this disease for over 50 years. Despite their effectiveness, these drugs require daily injections, have many side effects and present prolonged healing time. OBJECTIVE: To carry out a systematic literature review on the advances in the treatment of cutaneous leishmaniasis in the new world in the last ten years. METHODS: We conducted an electronic search on the Pubmed and LILACS database as well as on the SciELO electronic library in June 2009. The search words in English were: "cutaneous", "leishmaniasis" and "treatment". We included only randomized, double-blind and placebo controlled trials. We used the Jadad scale to assess the quality of the selected studies. RESULTS: According to the inclusion and exclusion criteria, only eight articles were selected. The drugs evaluated in the selected studies were glucantime®, miltefosine, immunotherapy, imiquimod, rhGM-CSF and pentoxifylline, and paromomycin. CONCLUSION: Although cutaneous leishmaniasis is a major public health issue, the published data on the use of new drugs for the treatment of cutaneous leishmaniasis in Brazil are still quite limited.

Avanços no tratamento da leishmaniose tegumentar do novo mundo nos últimos dez anos: uma revisão sistemática da literatura / Advances in the treatment of cutaneous leishmaniasis in the new world in the last ten years: a systematic literature review

INTRODUÇÃO: O arsenal terapêutico contra a leishmaniose tegumentar é muito restrito. Os antimoniais pentavalentes permanecem como as drogas de escolha para seu tratamento há mais de 50 anos. Apesar da sua eficácia, necessita de injeções diárias, apresenta muitos efeitos colaterais e tempo de cura prolongado.

INTRODUCTION: The therapeutic arsenal against cutaneous leishmaniasis is very limited. Pentavalent antimonial compounds have been the drugs of choice for treatment of this disease for over 50 years. Despite their effectiveness, these drugs require daily injections, have many side effects and present prolonged healing time.

Primary cutaneous folliculotropic and lymphohistiocytic anaplastic large cell lymphoma.

BACKGROUND: Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is a T-cell lymphoma that presents in the skin and consists of CD30+ anaplastic large lymphocytes with abundant cytoplasm and pleomorphic nuclei. In addition to the classic variant, several other histologic patterns of ALCL have been identified, among them the lymphohistiocytic variant. OBJECTIVE AND METHODS: We describe a case of the lymphohistiocytic variant of PC-ALCL with a marked follicular involvement. The lesion appeared as a single nodule in the face that completely regressed following biopsy. A diffuse infiltration of lymphocytes and macrophages was seen in the dermis associated with hypertrophied hair follicles, follicular mucinosis, and marked folliculotropism, leading to follicular disruption. Cohesive groups of CD30+ large, atypical lymphocytes with a high proliferative index were seen focally. The patient was followed up for 41 months, during which time no relapses occurred. CONCLUSIONS: This case shows that PC-ALCL may present with different histologic features, including a follicular variant, that may mimic both benign and malignant conditions.

Efficacy of topical combination of benzoyl peroxide 5% and clindamycin 1% for the treatment of progressive macular hypomelanosis: a randomized, doubleblind, placebo-controlled trial.

BACKGROUND: Progressive macular hypomelanosis is a dermatosis without definite etiology. There is no consensus or first-line therapy in the treatment of progressive macular hypomelanosis, and the treatment options used are very little effective. OBJECTIVE: To evaluate the therapeutic efficacy of the topical combination of benzoyl peroxide 5% and clindamycin 1% associated with sun exposure for the treatment of progressive macular hypomelanosis. MATERIALS AND METHODS: This is a randomized, double-blind, placebo-controlled study in which patients were divided into two groups. Group A used the topical combination of benzoyl peroxide 5% and clindamycin 1% and Group B used gel cream as a placebo. Patients were advised to expose themselves to the sun on a daily basis and were systematically evaluated and photographed. The collected data were entered and analyzed using Epi Info. A p value < 0.05 was considered statistically significant. RESULTS: Out of the 23 patients included in the study, 13 were in group A and 10 in group B. Eleven patients (85%) in group A had significant clinical improvement and only two patients (20%) in group B showed an equivalent clinical improvement (p = 0.003). Side effects were more frequent in group A (p = 0.003). CONCLUSION: The topical combination of benzoyl peroxide 5% and clindamycin 1% is effective in the treatment of progressive macular hypomelanosis.

Eficácia da combinação tópica de peróxido de benzoíla 5 por cento e clindamicina 1 por cento para o tratamento da hipomelanose macular progressiva: um estudo randomizado, duplo-cego, placebo-controlado / Efficacy of topical combination of benzoyl peroxide 5 percent and clindamycin 1 percent for the treatment of progressive macular hypomelanosis: a randomized, doubleblind, placebo-controlled trial

FUNDAMENTOS: A hipomelanose macular progressiva é uma dermatose sem etiologia definida. Não há consenso ou medicação de primeira linha para o seu tratamento e os tratamentos utilizados são pouco eficazes. OBJETIVO: Avaliar a eficácia terapêutica da combinação tópica de peróxido de benzoíla 5 por cento e clindamicina 1 por cento associada à exposição solar para o tratamento da hipomelanose macular progressiva. MATERIAIS E MÉTODOS: Trata-se de um estudo randomizado, duplo-cego, placebo-controlado, no qual os pacientes foram divididos em dois grupos: o Grupo A utilizou a combinação tópica de peróxido de benzoíla 5 por cento e clindamicina 1 por cento e o Grupo B usou um creme gel como placebo. Os pacientes foram orientados à exposição solar diária, avaliados e fotografados sistematicamente. Os dados coletados foram inseridos e analisados pelo software Epi Info. Definiu-se a significância estatística por valor de p<0,05. RESULTADOS: Dos 23 pacientes incluídos, 13 foram do Grupo A e 10, do Grupo B. Onze pacientes do primeiro grupo (85 por cento) obtiveram melhora clínica importante e apenas dois (20 por cento) do segundo grupo obtiveram uma melhora clínica equivalente (p=0,003). Os efeitos colaterais foram mais frequentes nos pacientes do Grupo A (p=0,003). CONCLUSÃO: A combinação tópica de peróxido de benzoíla 5 por cento e clindamicina 1 por cento é eficaz no tratamento da hipomelanose macular progressiva.

BACKGROUND: Progressive macular hypomelanosis is a dermatosis without definite etiology. There is no consensus or first-line therapy in the treatment of progressive macular hypomelanosis, and the treatment options used are very little effective. OBJECTIVE: To evaluate the therapeutic efficacy of the topical combination of benzoyl peroxide 5 percent and clindamycin 1 percent associated with sun exposure for the treatment of progressive macular hypomelanosis. MATERIALS AND METHODS: This is a randomized, double-blind, placebo-controlled study in which patients were divided into two groups. Group A used the topical combination of benzoyl peroxide 5 percent and clindamycin 1 percent and Group B used gel cream as a placebo. Patients were advised to expose themselves to the sun on a daily basis and were systematically evaluated and photographed. The collected data were entered and analyzed using Epi Info. A p value < 0.05 was considered statistically significant. RESULTS: Out of the 23 patients included in the study, 13 were in group A and 10 in group B. Eleven patients (85 percent) in group A had significant clinical improvement and only two patients (20 percent) in group B showed an equivalent clinical improvement (p = 0.003). Side effects were more frequent in group A (p = 0.003). CONCLUSION: The topical combination of benzoyl peroxide 5 percent and clindamycin 1 percent is effective in the treatment of progressive macular hypomelanosis.