Department of Dermatology, Nottingham University Hospitals Trust, Nottingham, U.K; Centre of Evidence Based Dermatology, Kings Meadow Campus, University of Nottingham, NG7 2RD, Nottingham, U.K.
Br J Dermatol. 2015 Apr;172(4):861-6. doi: 10.1111/bjd.13496.
A 5-year-old boy from rural Afghanistan presented with a 1-year history of a skin lesion on his left knee, confirmed by polymerase chain reaction to be cutaneous leishmaniasis (Leishmania tropica). Conventional treatment of cutaneous leishmaniasis involves intravenous or intralesional pentavalent antimonials. The aim of this Critically Appraised Topic (CAT) is therefore to determine what alternative effective but less painful treatments (such as oral or topical therapies) can be used to treat cutaneous leishmaniasis in children. Embase and PubMed were searched for 'cutaneous leishmania*' AND 'treatment' AND 'children' in August 2014. All abstracts from April 2008 to August 2014 were reviewed. This search period was chosen to follow on from the Cochrane reviews on Old World and American leishmaniasis. Five randomized controlled trials met our inclusion criteria and have been included in this CAT. The study design and reporting quality in most of the trials included in both Cochrane reviews was found to be poor, and neither Cochrane review investigated the effect of patient age on response to treatment. This CAT identified two nonpainful treatments, topical paromomycin and oral miltefosine, whose effective use in children is supported in the literature. However, both of these treatments are currently unlicensed in the U.K. Our patient was successfully treated with miltefosine 20 mg twice daily for 4 weeks, leading to good resolution of the leishmaniasis plaque but with residual scarring.
一位来自阿富汗农村的 5 岁男孩，其左膝上有一处皮肤病变，经聚合酶链反应证实为皮肤利什曼病（热带利什曼原虫）。皮肤利什曼病的常规治疗包括静脉内或病灶内注射五价锑剂。因此，这个关键性评价专题（CAT）的目的是确定可以使用哪些替代的有效但疼痛较轻的治疗方法（如口服或局部治疗）来治疗儿童皮肤利什曼病。2014 年 8 月，在 Embase 和 PubMed 上搜索了“皮肤利什曼*”和“治疗”以及“儿童”。回顾了 2008 年 4 月至 2014 年 8 月的所有摘要。选择这个搜索时间段是为了紧跟关于旧世界和美洲利什曼病的 Cochrane 综述。符合我们纳入标准的有 5 项随机对照试验，已被纳入这个 CAT。Cochrane 综述中纳入的大多数试验的研究设计和报告质量被认为较差，而且两个 Cochrane 综述都没有调查患者年龄对治疗反应的影响。这个 CAT 确定了两种无痛治疗方法，即局部注射巴龙霉素和口服米替福新，它们在文献中被证明对儿童有效。然而，这两种治疗方法目前在英国都没有获得许可。我们的患者成功地接受了米替福新 20mg，每日两次，共 4 周的治疗，导致利什曼病斑块得到很好的缓解，但仍有疤痕残留。
