Laser Combination Therapy Promising for Cutaneous Leishmaniasis

Combination therapy using ablative fractional laser resurfacing, in combination with laser-assisted delivery of topical paromomycin appears to be effective for treatment of leishmaniasis, according to a pilot study published in the December 2015 issue of Lasers in Surgery and Medicine (LSM). The research conducted by Andrew Basnett, MD; Tuyet A. Nguyen, BS; Christopher Cannavino, MD; and Andrew C. Krakowski, MD was selected as Editor’s Choice in that edition.

The manuscript titled, “Ablative fractional laser resurfacing with topical paromomycin as adjunctive treatment for a recalcitrant cutaneous leishmaniasis wound” was published in LSM, the official journal of the American Society for Laser Medicine and Surgery, Inc. (ASLMS).

A vector borne disease, leishmaniasis can cause manifestations that range from localized skin ulceration to lethal visceral disease. Despite an estimated 2 million cases annually due to increased global travel with “imported” cases (particularly cutaneous leishmaniasis (CL)) becoming more common in developed, non-endemic countries, current treatment options are still limited. Ablative fractional laser resurfacing (AFR) represents a treatment option and may address challenges commonly encountered in CL treatment.

 “A pilot study was conducted to investigate the utility of ablative fractional laser resurfacing, in combination with laser-assisted delivery of topical paromomycin, in the treatment of a recalcitrant leishmaniasis wound,” stated Dr. Krakowski.

“An adolescent female presented to Pediatric Dermatology with several non-tender, non-healing wounds on her bilateral upper and lower extremities after camping overnight in the Negev Desert, in Israel. Skin biopsy strongly suggested the diagnosis of cutaneous leishmaniasis; polymerase-chain-reaction testing by Centers for Disease Control and Prevention confirmed infection by Leishmania major.

“A 6-week course of oral fluconazole in conjunction with topical paromomycin healed all but the young woman's largest wound, located on her left medial lower leg. This recalcitrant lesion was subsequently treated with ablative microfractionated 10,600-nm carbon dioxide laser (Ultrapulse Encore Deep FX; Lumens, Ltd., Yokneam, Israel) and topical paromomycin applied immediately after laser surgery (i.e., laser-assisted delivery) and continued daily for a total of three months. Her infection resolved, and the lesion healed with minimal scarring in this sensitive anatomic location.

“The results of this single, unblinded study suggest this novel combination therapy may offer promise as a new treatment modality for cutaneous leishmaniasis infection while helping to accelerate wound healing and mitigate scarring.”