Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter To Editor
2007:73:5;361-362
doi: 10.4103/0378-6323.35750
PMID: 17921629

Localized cutaneous leishmaniasis in South India: Successful treatment with ketoconazole

M Kumaresan, Pramod Kumar
 Department of Skin and STD, Kasturba Medical College, Mangalore, Karnataka, India

Correspondence Address:
M Kumaresan
Department of Skin and STD, Kasturba Medical College, Mangalore - 575 001, Karnataka
India
How to cite this article:
Kumaresan M, Kumar P. Localized cutaneous leishmaniasis in South India: Successful treatment with ketoconazole. Indian J Dermatol Venereol Leprol 2007;73:361-362
Copyright: (C)2007 Indian Journal of Dermatology, Venereology, and Leprology
Figure 3: Leishman Donovan bodies inside the macrophages (H and E, x400)
Figure 3: Leishman Donovan bodies inside the macrophages (H and E, x400)
Figure 2a: Case 3: Cutaneous leishamaniasis, before treatment Figure 2b: Case 3: Cutaneous leishamaniasis, after treatment
Figure 2a: Case 3: Cutaneous leishamaniasis, before treatment Figure 2b: Case 3: Cutaneous leishamaniasis, after treatment
Figure 1a: Case 2: Cutaneous leishamaniasis, before treatment Figure 1b: Case 2: Cutaneous leishamaniasis, after treatment
Figure 1a: Case 2: Cutaneous leishamaniasis, before treatment Figure 1b: Case 2: Cutaneous leishamaniasis, after treatment

Sir,

Leishmaniasis is a protozoal infestation caused by several species of the genus Leishmania . The disease, once restricted to certain geographical areas in India, is now showing a trend to spread to previously nonendemic areas. Hence, there are reports of new foci of infection from various parts of India. [1],[2],[3] There is no optimal treatment protocol for all forms of cutaneous leishmaniasis (CL). The therapeutic regimen for CL should be based on clinical experience and efficacy vs toxicity of the commonly used drugs in each endemic area. We report three cases of cutaneous leishmaniasis diagnosed histopathologically in a nonendemic area that are treated successfully with oral ketoconazole.

Our first case was a 39-year-old female who presented with an erythematous plaque that showed ulceration and crusting of the surface. The lesions were present over the right forearm since 2 months. The second case was a similar one: a 10-year-old boy presented with an erythematous ulcerated plaque of 3 months duration over the right cheek [Figure - 1]a . The third patient was a 20-year-old female who presented with an erythematous ulcerated plaque of 1 month duration over the right forearm [Figure - 2]a . All the three patients belonged to Kasargod district in the Western Ghats region of South India. None of them had traveled to the endemic areas for CL in the past. Cutaneous leishmaniasis was suspected in these cases on clinical grounds. In all the three patients, biopsy confirmed the diagnosis revealing LD bodies inside the macrophages [Figure - 3], although culture could not be performed. The patients were treated with oral ketoconazole (200mg twice daily for patients 1 and 3 and 100 mg once daily for patient 2) for a period of 3 months. Patients were followed up every 2 weeks. Complete hemogram, liver and renal function tests were performed for all the patients before commencing and after completion of the treatment.

At the end of 3 months of the treatment, clinical cure was observed in all the patients [Figure - 1]b, [Figure - 2]b. No adverse effect of the drug was noted at the end of the treatment period. The patients were followed up for a duration of 6 months and none of them showed recurrence. All the patients tolerated ketoconazole well.

Imidazole derivatives are potential therapeutic agents in cutaneous leishmaniasis. They act by interfering with the synthesis of ergosterol [4] that is present in large concentrations in the cell wall of Leishmania spp. The efficacy of ketoconazole in different doses for variable periods in both old and new world cutaneaous leishmaniasis has been documented in several studies. [5]

In Kerala, the cases of CL have been reported from Malappuram [1] and Trivandrum. [6] We diagnosed three cases of CL from the Kasargod district of Kerala for the first time. This is of considerable public health interest in view of a newly recognized reservoir area of CL in South India. Further investigations are required to identify the Leishmania species, reservoir and the vector in this area.

References
1.
Bora D, Khera AK, Mittal Veena, Kaul SM, Sharma RS. New focus of cutaneaous leishmaniasis in India: Preliminary report. Indian J Dermatol Venereol Leprol 1996;62:19-21.
[Google Scholar]
2.
Sharma RC, Mahajan VK, Sharma NL, Sharma A. A new focus of cutaneous leishmaniasis in Himachal Pradesh (India). Indian J Dermatol Venereol Leprol 2003;69:170-2.
[Google Scholar]
3.
Kalla Gyaneshwar, Singhi MK Cutaneous Leishmaniasis in Jodhpur District. Indian J Dermatol Venereol Leprol 1996;62:149-51.
[Google Scholar]
4.
Bergers M. Mechanism of antifungal drugs with special reference of Imidazole derivatives. Rev Infect Dis 1980;2:520-34.
[Google Scholar]
5.
Urcuyo FG, Zaias N. Oral ketoconazole in treatment of leishmaniasis. Int J Dermatol 1982;21:414-6.
[Google Scholar]
6.
Lohidakshan MU, Shanmugham Pillai SM, Vijayadharan M, Sarojini PA. Two cases of cutaneous leishmaniasis in Trivandrum. Indian J Dermatol Venereol Leprol 1988;54:161-2.
[Google Scholar]

Fulltext Views
101

PDF downloads
35
Show Sections