Successful treatment of lupoid cutaneous leishmaniasis with glucantime and topical trichloroacetic acid (a case report)

Abstract

Lupoid leishmaniasis is a unique form of cutaneous leishmaniasis characterized by unusual clinical features and a chronic relapsing course, mostly caused by infection with Leishmania tropica. In this clinical form, 1-2 yr after healing of the acute lesion, new papules and nodules appear at the margin of the remaining scar. Herein, we describe a case of this clinical form that was resistant to 2 courses of treatments: systemic glucantime and then a combination therapy with allopurinol and systemic glucantime. However, marked improvement was seen after a combination therapy with topical trichloroacetic acid solution (50%) and systemic glucantime, and there were no signs of recurrence after 1 yr of follow-up.

Fig. 1

Large atrophic scar (arrow) on the nose with red infiltrative nodules at the margin.

Fig. 2

Pseudoepitheliomatous hyperplasia of epidermis with small tuberculoid granuloma and mild to moderate mononuclear cell infiltrates (A ×40; B ×100).

Fig. 3

Frosting the lesion after application of 50% TCA solution.

Fig. 4

The patients after 1 yr of follow-up showing complete healing of the lesion.