Interventions for Old World cutaneous leishmaniasis.

Area of Science:

• Dermatology
• Infectious Diseases
• Parasitology

Background:

• Cutaneous leishmaniasis (CL) is a significant parasitic skin disease prevalent in low- and middle-income countries.
• Old World cutaneous leishmaniasis (OWCL) is caused by specific Leishmania species across Africa, Asia, the Middle East, and the Mediterranean.
• Current treatments, including antimonials, show variable success, necessitating updated evidence on therapeutic interventions.

Purpose of the Study:

• To evaluate the efficacy and safety of various therapeutic interventions for localized Old World cutaneous leishmaniasis.
• To update a previous Cochrane Review by incorporating new randomized controlled trials (RCTs).

Main Methods:

• Conducted an updated systematic search of multiple databases and trials registers up to November 2016.
• Included randomized controlled trials (RCTs) comparing treatments against placebo, vehicle, or other active compounds in immunocompetent individuals with OWCL.
• Two independent reviewers assessed trial eligibility, risk of bias, and extracted data, synthesizing findings where possible.

Main Results:

• Included 89 studies with 10,583 participants; most studies had unclear or high risk of bias.
• Oral itraconazole showed a potential benefit over placebo for cure, but with very low certainty evidence and increased mild side effects.
• Paromomycin ointment demonstrated no significant difference in cure rates compared to vehicle, but with more local skin reactions, also with very low certainty evidence.

Conclusions:

• There is very low certainty evidence supporting the effectiveness of itraconazole and paromomycin ointment for OWCL cure.
• Both interventions were associated with more adverse effects than comparators, but safety conclusions could not be drawn due to evidence limitations.
• High-quality, large-scale international studies are needed to reliably assess treatment efficacy, safety, and specific Leishmania species.