U.S. and Saudi doctors say an oral drug commonly used for fungal ailments speeds healing of the skin form of the tropical disease leishmaniasis. A new study shows it lacks the side effects of the older injection drugs.
Cutaneous leishmaniasis comes from the bites of sand flies, which transmit the leishmania parasite from dogs and rodents. It is so common in some regions that Arabs call it "little sister" because it is like a member of the family.
Leishmaniasis is not pretty. When it infects the skin, it causes disfiguring sores that look like craters. Although it is not fatal and is self-healing after several months, World Health Organization leishmaniasis expert Philippe Desjeux says there are times drugs are necessary. "When you have several lesions and when you have a very bad location - on the face, for example in that case, really, you need to treat and quickly," he said.
Antimony compounds are the main therapy against all leishmaniasis, including the often fatal version called kala-azar that attacks organs. But they require injection or infusion and have severe side effects.
Now, U.S. and Saudi doctors report in The New England Journal of Medicine that they have identified a safe, oral treatment called fluconazole for the skin form of the disease. Parasitic diseases expert James Maguire of the U.S. Centers for Disease Control participated in a study that tested the drug on more than 100 patients in the Al-Ahsaa and Riyadh regions of Saudi Arabia.
"We treated one group with fluconazole and one group with placebo, or sugar pill, and then monitored the response to therapy," he said. "What we were able to show was that the group that received the drug fluconazole had a much more rapid healing of their lesions."
The patients took either fluconazole or the placebo daily for six weeks. Three months after treatment ended, 79 percent of those given the drug were completely healed, compared to only 34 percent in the placebo group.
But fluconazole has limits. Although effective against the most common cutaneous leishmaniasis parasite in the Middle East and parts of Africa, it works poorly on other local species of the organism and on those in South Asia and South America.
It is also expensive, as Dr. Maguire points out. "For it to become widely available, it would need to be either provided free of charge or at reduced rates, perhaps through government programs, through non-governmental organizations, or perhaps by some negotiations with the providers of the drug," he said.
Dr. Maguire and his Saudi colleagues say the decision to use it should be balanced against its cost and the ability of patients to adhere to the daily treatment regimen.
Dr. Desjeux, of the World Health Organization, says it is important to develop treatments for use in regions where fluconazole does not work, because Cutaneous Leishmaniasis is becoming more severe. He points in particular to Afghanistan and Afghan refugees in Pakistan. "We need a good treatment for these patients, even if the disease is not fatal, there are poor people living in remote areas and we should continue investing in looking for the best drugs for these patients," he said.
There is also an oral drug on the horizon for the fatal form of leishmaniasis, kala-azar, which is endemic in South Asia. Studies show that a cancer therapy called miltefosine has as much promise as fluconazole does for the skin type. Dr. Desjeux says the Indian government will soon become the first to approve it for general use.