1. Efficacy of Fractional wave CO 2 Laser (10600nm) For Treating Cutaneous Leishmaniasis Dr. Eshtyag Abdeen Ali Dermatologist

2. Cutaneous Leishmaniasis Protozoal disease caused by parasite belonging to the genus Leishmania transmitted by sand flies sub-type of phelobotomaniae.

3. Epidemiology endemic in developing countries. Incidence more than 400,000 cases annually Prevalence ( all forms ) more than 12 million. Although it is frequently seen in the Middle East, Christopherson first reported lupoid Cutaneous Leishmaniasis in the English literature in 1923

4. Cutaneous Leishmaniasis (CL) is self-healing BUT ??? 3Ds Duration is long (months, sometimes years) Disfiguring scar Destruction of underline structure ( ear, nose)

5. Treatment: There is no standardized treatment multiple treatments have been reported with varying degrees of success. Treatment options include: cryotherapy,topical antimonial compounds and intra lesional and systemic pentavalent antimony

6. Recently Carbon-Dioxide laser has been used to vaporize the local lesions with excellent results and satisfactory esthetic outcomes. In the current study, we evaluated the results of the treatment of Cutaneous Leishmaniasis with fractional-wave CO 2 laser.

7. Objectives To study the efficacy and safety of Carbon Dioxide Laser in treatment of Cutaneous Leishmaniasis and healing duration.

8. Material And Methods: Prospective study 10 cases. This study was carried out in Sudan University for Science and Technology Conducted between February - September 2014. Diagnosis of Cutaneous Leishmaniasis was made clinically and confirmed by positive smear for Donvan body.

9. Inclusion Criteria: Patients of Cutaneous Leishmaniasis were included regardless of age, sex, race, social status or occupation. Exclusion Criteria: 1- chronic systemic disease (renal failure, myocarditis, hepatitis. ) 2- immune suppression 3- pregnancy 4- breast feeding 5- patients receiving other specific anti leishmanial therapies.

10. (between 10-15 Watt fractional wave, duty time 500µs, idle time 0.005s, space o.2mm, graphic circle, diameter depend on the lesion size) was applied to the lesions and an area 2–3 mm around it. Follow-up evaluation was performed by clinical assessment of treated lesions at weeks 2, 4, 6 and 12.

11. Results and Discussion In this study there were 10 patients.Their mean age was 22.5 years

13. Number and Site of Lesions : The total number of lesions was 1 3 Arm 5 lesions 38.4% Hand 3 lesions 23.1% Leg 2 lesions 15.4% Forearm 2 lesions 15.4% Foot 1 lesion 07.1%

14. Size of lesions

15. Ulcerated plaque was found in 9 lesions (69.2%), 2 lesions had nodular shape (15.3%) and another 2 lesions had papules shape (15.3%)( table 3.2).. numbermorphology 2 (15.3%)papules 2 (15.3)%nodules 9 (69.4%)plaques Morphology of Lesions:

16. Duration of Lesions: Duration per month Number of Lesions 19 23 Less than one1

17. Outcome of CO 2 treatment: First week all patients had dry coagulated film that formed over the ulcers. One patient his ulcer showed element of infection treated with topical antibiotics. Two patients had erythema which subsided within 3-5 days. No patients required analgesia post procedure

18. No elements of lymphadenitis in all patients. One patient with healthy ulcer had smear after one week from the session which came as negative for Donovan body. The rest of the patients we relayed on clinical parameters for cure.

19.  Second week All coagulated films were fallen, exposing pink granulation tissue. Ulcers were healed, with decrease in diameter about 8-10% in seven lesions and became shallower. Forth week all ulcers healed and covered with thin epithelial layer.

20. sixth week  the ulcers (3) of less than 2 cm healed without scar . The ulcers (2) of 2-5 cm healed with scar with 50% reduction in the size.  The ulcers (8) of 5 cm or more the size decreased by 10 %.

21. Figure (3.4): Healing types

22. Side effect Hypo pigmentation hyper pigmentation Three patients had hypo pigmentation, six had hyper pigmentation

23. Picture No (1) Lesion before treatment Immediately after laser session Islands of epithelization after1 week

24. Before treatment Healed lesions after 6 weeks Lesion before treatment Immediately after laser session

25. r Lesion before treatment Immediately after laser session Healed lesions after 6 weeks

26. Immediately after laser session Lesion before treatment

27. Conclusion : The result of this study and others suggest that Cutaneous Leishmaniasis can be treated effectively with CO 2. Excellent cosmetic out come Short duration of healing No evidence of recurrence after treatment by co2 laser. Laser treatment although expensive than other treatment but can be used as first line therapy for Cutaneous Leishmaniasis (short duration, better outcome and safe)

28. Thank you