Treatment of Acute Cutaneous Leishmaniasis by Oral Zinc Sulfate and Oral Ketocanazole Singly and in Combination

Abstract

Background: Cutaneous Leishmaniasis (CL) is an endemic disease in many countries and caused by different species of Leishmania parasite. It results in a deformed scar after a relatively long period. Many therapies have been tried in treatment of this disease. Objective: To compare the effect of oral zinc sulfate and oral ketoconazole singly and in combination in the treatment of acute cutaneous leishmaniasis. Patients and Methods: This single, blinded, therapeutic, controlled study was conducted in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq, during the period, January 2015 to July 2015. Seventy-five patients with acute CL were enrolled in this study. The total numbers of lesions were 327, and the duration of lesions ranged from 4 to 12 (6.9 ± 0.7) weeks. The diagnosis was confirmed by smear and histopathology. Patients were divided into three groups: 24 patients in Group A were treated with oral zinc sulfate capsules 10 mg/kg/day for 6 weeks; 24 patients in Group B were treated with ketoconazole tablets 200 mg twice daily for 6 weeks and 27 patients in Group C were treated orally with a combination of zinc sulfate and ketoconazole for 6 weeks. All patients were seen regularly every 2 weeks for 6 weeks of treatment period, then monthly for the next three months as follow up period. Healing of the lesions was assessed by using Sharquie's modified Leishmania score to assess the objective response to the topical or systemic therapy. Results：After six weeks, 75 patients have completed the treatment, 24patients received zinc sulfate capsule, 24 patients received oral ketoconazole and 27 patients received a combination of both treatments. The cure rate was (60%) in the group receiving oral zinc sulfate capsuleand (50%) in the one receiving oral ketoconazole tablet (P = 0.146) and (96%) in the combination group (P ˂ 0.04). Conclusion: The combination therapy using oral zinc sulfate and oral ketoconazole gave a high cure rate. The combination therapy is a new mode of therapy as both drugs act in a synergistic way.

Cutaneous Leishmaniasis in Erbil Governorate: Clinical manifestations and disease course

“…The time span of lesion improvement from the onset of treatment was 1.5 to 4.8 months, with the mean of 2.8±0.3. This result is not consistent with the literature and published data from other parts of Iraq that indicated CL improves in response to standard treatment within 6 weeks (11). Another group of authors from Iraq demonstrated that after the initiation of antileishmania treatment, CL lesion heals within 4 weeks in the majority of patients (12).…”

The Safety of Oral Ketoconazole in the Treatment of Skin Diseases (Single Blinded, Therapeutic, Comparative Study)

“…This diversity of cure rate could be explained by the higher dose of ketoconazole and the different scoring system and no side effects were reported. While Sharquie et al (15) used ketoconazole as a single therapy for leishmaniasis and gave 50% cure rate, and in a combination of oral ketoconazole and zinc sulfate gave a cure rate of 96%, and by using Tuckey HSD test suggests that this combination has synergistic effect.…”

“…Cutaneous Leishmaniasis (CL) is an endemic disease in many countries including Iraq and many drugs were used in treatment of CL and KC is one of them. In Sharquieetal study, we used KC singly and in combination with oral zinc sulphate, and the results were very encouraging [15].…”

BCG is a Good Immunotherapeutic Agent for Viral and Autoimmune Diseases: Is it a New Weapon against Coronavirus (COVID-19)?

“…A number of studies have treat various medical problems via the use of oral zinc sulfate (including viral warts (46), herpes simples infections (47), and acute cutaneous leishmaniasis) (48)(49)(50). Zinc sulfate is also used as a therapy for autoimmune diseases like alopecia areata (51), Behcet's disease (52), and recurrent aphthous stomatitis (53).…”