皮肤利什曼病的治疗进展
A Therapeutic update on Cutaneous leishmaniasis.
作者信息
Bari Arfan Ul, Rahman Simeen Ber
机构信息
Department of Dermatology, PAF Hospital, Sargodha, Pakistan.
出版信息
J Coll Physicians Surg Pak. 2003 Aug;13(8):471-6.
Leishmaniasis, in its visceral (VL), cutaneous (CL) and mucocutaneous (MCL) forms, directly affects hundreds of thousands people per annum, with millions of individuals at risk worldwide. Cutaneous leishmaniasis (CL) is an infective skin disease that manifests as ulcerated nodules, upto several centimeters in size, which are quite resistant to treatment. A wide variety of therapeutic modalities have been employed for cutaneous leishmaniasis. However, none has been demonstrated to be good enough as the first-line therapeutic agent to treat patients in all the epidemiological scenarios. Although pentavalent antimonials are widely used in the treatment of all forms of leishmaniasis, the response is far from satisfactory. These must be administered parenterally with occurrence of therapeutic failures. Secondary treatments incorporate amphotericin B, which is highly active but its use is limited by extensive toxicity complications and high cost. Several oral drugs, such as pentamidine, ketoconazole and itraconazole, have also been tested. Results obtained are not entirely satisfactory. The majority of topical agents have been tested in non-controlled studies, with only few subjects. The interpretation of results is usually difficult due to the lack of a standard and well-accepted cure definition. There remains a pressing need for new anti-leishmanials. This review is focused upon the current status of chemotherapy, the various avenues being investigated by researchers and their potential application in the future.
利什曼病有内脏型(VL)、皮肤型(CL)和黏膜皮肤型(MCL),每年直接影响数十万人,全球数百万人面临感染风险。皮肤利什曼病(CL)是一种感染性皮肤病,表现为大小可达数厘米的溃疡性结节,对治疗相当耐药。治疗皮肤利什曼病已采用了多种治疗方式。然而,尚无一种被证明足以作为一线治疗药物在所有流行病学情况下治疗患者。尽管五价锑剂广泛用于治疗各种形式的利什曼病,但其疗效远不能令人满意。这些药物必须通过肠胃外给药,且会出现治疗失败的情况。二线治疗药物包括两性霉素B,它具有高活性,但由于广泛的毒性并发症和高成本,其应用受到限制。几种口服药物,如喷他脒、酮康唑和伊曲康唑,也已进行了测试。所获结果并不完全令人满意。大多数局部用药仅在少数受试者身上进行了非对照研究测试。由于缺乏标准且被广泛接受的治愈定义,结果的解读通常很困难。对新型抗利什曼病药物仍有迫切需求。本综述重点关注化疗的现状、研究人员正在探索的各种途径及其未来的潜在应用。