Efficacy of Thermotherapy to Treat Cutaneous Leishmaniasis Caused by Leishmania tropica in Kabul, Afghanistan: A Randomized, Controlled Trial

(See the editorial commentary by Wortmann on pages 1156–8) Background. Pentavalent antimony is the agent recommended for treatment of cutaneous leishmaniasis (CL). Its use is problematic, because it is expensive and because of the potential for drug-associated adverse effects during a lengthy and painful treatment course. Methods. We tested the efficacy of thermotherapy for the treatment of CL due to Leishmania tropica in a randomized, controlled trial in Kabul, Afghanistan. We enrolled 401 patients with a single CL lesion and admin-istered thermotherapy using radio-frequency waves (1 treatment of 1 consecutive application at 50C for 30 s) or sodium stibogluconate (SSG), administered either intralesionally (a total of 5 injections of 2–5 mL every 5–7 days, depending on lesion size) or intramuscularly (20 mg/kg daily for 21 days). Results. Cure, defined as complete reepithelialization at 100 days after treatment initiation, was observed in 75 (69.4%) of 108 patients who received thermotherapy, 70 (75.3%) of 93 patients who received intralesional SSG, and 26 (44.8%) of 58 patients who received intramuscular SSG. The OR for cure with thermotherapy was 2.80 (95 % confidence interval [CI], 1.45–5.41), compared with intramuscular SSG treatment (). No statisticallyPp.002 significant difference was observed in the odds of cure in comparison of intralesional SSG and thermotherapy treatments. The OR for cure with intralesional SSG treatment was 3.75 (95 % CI, 1.86–7.54), compared wit