Liquid nitrogen cryotherapy on Leishmania donovani cutaneous leishmaniasis

Abstract

Objective: To evaluate the efficacy and the safety of liquid nitrogen cryotherapy (LN) on Leishmania donovani cutaneous leishmaniasis and on type V skin. Methods: LN was applied to 65 patients (121 lesions) using cotton swabs attached to ekels. Cryosessions were performed for 15–20 seconds, two per site, weekly for 1–3 weeks, fortnightly for 4–5 weeks and then monthly until cure. Patients were followed-up for 6 months after cure. Results: A total of 91.7% of patients were cured within one to seven cryosessions; mean 3.57. With one to four cryosessions, papules ≤ 1 cm in diameter showed rapid healing (90.5%) in comparison with those of > 1 cm diameter (64.28%). The cure rates for lesions on the head (84.61%) and upper limb (82.6%) were greater than those for the lower limbs (71.42%) and trunk (66.66%). With LN, local pain lasted for 15–30 minutes; ulceration (33%), depigmentation (46.9%) and scarring (43%) were noticed. During 6 months of follow-up there was one (1.6%) recurrence. Conclusions: LN (77.15% cure within one to four cryosessions) is an alternative to intralesional sodium stibogluconate in the treatment of papules measuring ≤ 1 cm. In type V skin, LN should be avoided on the face, and on patients who have a tendency to form keloids. We recommend giving cryotherapy using cryoguns (instead of cotton swabs attached to ekels) fortnightly (not weekly), which may minimize ulceration, and therefore scarring.

Key words::

• cryotherapy
• 7% hypertonic saline
• Leishmania donovani cutaneous leishmaniasis
• sodium stibogluconate

Acknowledgements

The authors thank Dr Chandrani Subasinghe and Mrs Prema Ekanayake (nursing officer) from the Department of Dermatology, Teaching Hospital Anuradhapura, who assisted us during preparation of the drugs and with treatment of the patients.

Declaration of interest: The authors declare there were no conflicts of interest and no funding.