背景:皮肤利什曼病(CL)的联合治疗可加速愈合并减少瘢痕形成的机会,尤其是在审美接受的地方,是必需的。
目的:评估病灶内注射葡糖酸钠(SSG)和局部5%咪喹莫特乳膏(IMI)的组合是否可加速愈合并改善CL疤痕的质量。
方法:前瞻性,安慰剂对照,随机临床试验在巴士拉教学医院进行,巴士拉,2017年至2019年伊拉克南部CL患者队列。符合条件的患者每周一次注射葡萄糖酸钠(SSG),持续六周,并随机接受局部用咪喹莫特5%乳膏(IMI组)或局部润肤乳膏(安慰剂组)。在第6周评估愈合率和瘢痕质量。
结果:121名患者完成了试验(66[55%]男性,平均年龄SD:34.1岁)。IMI组的临床治愈率明显高于安慰剂组(94%对74%,p<0.05)。在两组中都发现了较高的疤痕率(IMI组为66.6%,安慰剂组为91.2%)。然而,在IMI组中,浅表性非萎缩性疤痕更常见(40%对26%),而深度萎缩性疤痕在安慰剂组比IMI组更明显(65.2%对26.6%,p<0.05)。
结论:病灶内SSG联合局部咪喹莫特有利于加速CL愈合和改善瘢痕质量,当CL位于美学敏感区域时,应考虑。
BACKGROUND: A combination treatment of cutaneous leishmaniasis (CL) that hastens the healing and reduces the chance of scarring, especially in aesthetically receptive sites, is required.
OBJECTIVE: To evaluate if a combination of intralesional sodium stibogluconate (SSG) injection and topical
imiquimod 5% cream (IMI) accelerates healing and improves the quality of scars from CL.
METHODS: A prospective, placebo-controlled, randomized clinical trial was conducted at Basrah Teaching Hospital, Basrah, southern Iraq from 2017 to 2019 on a cohort of patients with CL. Eligible patients were injected intralesionally with sodium stibogluconate (SSG) weekly for six weeks and randomized to receive either topical
imiquimod 5% cream (IMI group) or topical emollient cream (placebo group). The healing rate and scar quality were assessed at week six.
RESULTS: One hundred twenty-one patients completed the trial (66 [55%] males, mean age SD: 34.1 years). The clinical healing rate was significantly higher in the IMI group than in the placebo group (94% versus 74%, p <0.05). A high rate of scars was noticed in both groups (66.6% in the IMI group and 91.2% in the placebo group). However, superficial non-atrophic scars were more frequent in the IMI group (40% versus 26%), while deep atrophic scars were more evident in the placebo group than in the IMI group (65.2% versus 26.6%, p<0.05).
CONCLUSIONS: Combined intralesional SSG plus topical
imiquimod was beneficial in accelerating CL healing and improving scar quality, and should be considered when CL is located in aesthetically sensitive areas.