Liquid nitrogen cryotherapy on Leishmania donovani cutaneous leishmaniasis.
OBJECTIVE
To evaluate the efficacy and the safety of liquid nitrogen cryotherapy (LN) on Leishmania donovani cutaneous leishmaniasis and on type V skin.


METHODS
LN was applied to 65 patients (121 lesions) using cotton swabs attached to ekels. Cryosessions were performed for 15-20 seconds, two per site, weekly for 1-3 weeks, fortnightly for 4-5 weeks and then monthly until cure. Patients were followed-up for 6 months after cure.


RESULTS
A total of 91.7% of patients were cured within one to seven cryosessions; mean 3.57. With one to four cryosessions, papules ≤ 1 cm in diameter showed rapid healing (90.5%) in comparison with those of > 1 cm diameter (64.28%). The cure rates for lesions on the head (84.61%) and upper limb (82.6%) were greater than those for the lower limbs (71.42%) and trunk (66.66%). With LN, local pain lasted for 15-30 minutes; ulceration (33%), depigmentation (46.9%) and scarring (43%) were noticed. During 6 months of follow-up there was one (1.6%) recurrence.


CONCLUSIONS
LN (77.15% cure within one to four cryosessions) is an alternative to intralesional sodium stibogluconate in the treatment of papules measuring ≤ 1 cm. In type V skin, LN should be avoided on the face, and on patients who have a tendency to form keloids. We recommend giving cryotherapy using cryoguns (instead of cotton swabs attached to ekels) fortnightly (not weekly), which may minimize ulceration, and therefore scarring.
Ranawaka
Ranthilaka R
RR
Department of Dermatology, Teaching Hospital Anuradhapura, Sri Lanka. ranthilaka37@yahoo.com
Weerakoon
Hema S
HS
Opathella
Nandimithra
N
D017679:Cryotherapy / Q000009:adverse effects; D006801:Humans; D007893:Leishmania donovani; D016773:Leishmaniasis, Cutaneous / Q000469:parasitology / Q000628:therapy*; D009584:Nitrogen
D009584:Nitrogen