PHARMACOLOGY AND THERAPEUTICS INTRALESIONAL TREATMENT OF CUTANEOUS LEISHMANIASIS WITH SODIUM STIBOGLUCONATE ANTIMONY RAJAB M. FARIS, M.D., JAMAL S. JARALLAH, M.B.B.S., M.Sc, M.R.C.G.P., TAWFIK A. KHOJA, M.B.B.S., D.I.P., P.H.C., M.R.C.G.P., AND MOHAMMAD J. AL-YAMANI, PH.D. Abstract Background. Cutaneous leishmaniasis represents a diffi- cult disease to manage in endemic areas. Systemic treat- ment is hampered by both expense and compliance. Side effects may play a major role in this aspect as well. Methods. The effectiveness of intralesional treatment of leishmaniasis was investigated. Seven hundred and ten pa- tients were treated with injections of sodium stiboglu- conate intralesionally. The clinical diagnosis was confirmed by demonstrating the parasite in the smears obtained from the lesion. Fine insulin needle was used to infiltrate the le- sion with sodium stibogluconate (0.5 to 1.0 mL). Results. Generally eight injections were sufficient, but some of the complicated lesions needed up to 24 injections. Sixty-two percent of patients were men. The majority of the study population (64%) were children below 15 years of age. The results showed that 72% of lesions healed com- pletely, 23.9% showed some improvement, while 4.1% showed some deterioration. Lesions of the lips, cheeks, chin, and neck healed faster than lesions in other parts of the body. Side effects were mild and limited to pain at the site of the injection and hyperpigmentation in those who were treated by folk medicine. Conclusions. Intralesional treatment is as effective as the standard systemic antimonials. It offers a less expensive al- ternative and a low side effects profile. Our findings con- firmed the findings of earlier workers. It is recommended for treatment of cutaneous leishmaniasis in endemic areas. Int J Dermatol 1993; 32:610-612 Cutaneous leishmaniasis is endemic in the Kingdom of Saudi Arabia,'"* the most common pathogen being due to Leishmania major and Leishmania tropica.^ From the Department of Family and Community Medicine, College of Medicine, and the Department of Clinical Pharma- cy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Address for Correspondence: Dr. Jamal S. Jarallah, Depart- ment of Family and Community Medicine (34), College of Medicine—King Saud University, P.O. Box 2925, Riyadh 11461, Kingdom of Saudi Arahia. Treatment of this disease is an important control measure, and in this respect sodium stibogluconate and N-methylglocamine antimonate are the drugs of choice; however, because of the significant side effects reported with the parenteral administration of these drugs, alter- native therapeutic measures were advocated/ These in- cluded antifungal agents,*"" rifampin,' combination therapy,^ topical treatment,'""^^ and dapsone." These measures were met with various degree of success. Intralesional treatment of cutaneous leishmaniasis was found to have many advantages and was recom- mended by several authors.'''"'^ In the present study we report our experience with intralesional sodium sti- bogluconate in the treatment of cutaneous leishmania- sis in Al-Baha region in the south-west of Saudi Arabia. Materials and Methods A total of 710 patients with typical acute cutaneous leish- maniasis with an average duration of symptoms of 3 months were enrolled in this study as part of the control program of cutaneous leishmaniasis in Al-Baha region in the south-west of Saudi Arabia. Diagnosis was confirmed both clinically and by labora- tory demonstration of the parasite in the lesions by direct smears or culture as follows: the lesions were cleaned by alcohol swab. Saline 0.9% was injected at the edge of the ulcer using a fine needie. The material was aspirated and stained with Giemsa. Samples were also cultured in either NoyMacNeal Nicolle or Ivans blood agar medium for up to 18 days to detect the leishmanial promastigotes. After confirmation of the diagnosis, a fine insulin needle was used to inject individual lesions with sodium stiboglu- conate (100 mg/mL, 0.5-1 mL) depending on the size of the ulcer. The needle was moved in all directions to ascertain the infiltration of the whole lesion. This procedure was re- peated on alternate days (8 injections). Some of the patients with lesions complicated by infection, previous cautery, or cryotherapy needed more injections (up to 24 injections) and were followed up for 3 months after cure. Special pre- cautions were taken if the lesions were on the eyelids. Lesions that were secondarily infected were treated by systemic antibiotic (rifampicin, 600 mg daily, for 5 days) and/or topical antibiotic or ketoconazole, followed by intrale- sional sodium stibogluconate. The use of topical cortisone caused no improvement of the lesions and was, therefore, discarded early in the study. The lesions were categorized as 610