Usefulness of ultrasound for treatment and follow-up of cutaneous leishmaniasis
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TECHNICAL REPORTS
Usefulness of ultrasound for treatment and follow‑up of cutaneous leishmaniasis L. Vergara‑de‑la‑Campa1 · H. Cembrero‑Saralegui2 · L. Luna‑Bastante1 · E. R. Martínez‑Lorenzo1 · F. Alfageme‑Roldán2 Received: 8 October 2020 / Accepted: 9 November 2020 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2020
Abstract Purpose Local therapy is the preferred option of treatment for most cutaneous leishmaniasis (CL); however, local therapy could be challenging, depth and size of the skin lesions are not always clinically evident and treatment response evaluation could occasionally be misleading. High frequency ultrasound is a non-invasive imaging tool which allows initial depth assessment ultrasound-guided infiltrations and ultrasound monitoring until resolution. Methods We present two cases of CL treated with ultrasound-guided infiltrations and ultrasound monitoring until resolution. Results Ultrasound imaging allowed a more accurate diagnosis of CL, defining more precisely the depth and size of the skin lesions. During follow-up, progressive decrease in dermal involvement, marked attenuation of the echogenicity of subcutaneous cellular tissue and a decrease in vascularization in the color Doppler mode was observed, which aided in evaluation of treatment response. Hypodermal inflammation observed through sonography was addressed with image-guided infiltration. Conclusion We would like to highlight the usefulness of skin ultrasound (both B-mode and color Doppler mode) in the diagnosis, depth assessment, imaging guided treatment, and follow-up in CL. Keywords Leishmaniasis · Cutaneous leishmaniasis · Dermatologic ultrasound · Skin ultrasound
Introduction Cutaneous leishmaniasis (CL) is the most common clinical form of leishmaniasis in the world [1]. This parasitic infection causes chronic skin lesions, typically on sun-exposed areas and usually affecting the facial area and extremities. These lesions can later result in unsightly scarring, especially when the face is involved [2, 3]. Local therapies, such as intralesional injections of pentavalent antimonial drugs, are preferred for localized CL [2]. Treatment responses are evaluated weekly or monthly through clinical examination, which could occasionally be misleading [1]. High-frequency ultrasound is a noninvasive imaging tool that represents tissues with high definition and elevated clinical utility [4, 5]. * L. Vergara‑de‑la‑Campa [email protected] 1
Dermatology Department, Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Ctra Cobisa S/N, 45071 Toledo, Spain
Dermatology Department, Hospital Puerta de Hierro de Madrid, Madrid, Spain
2
We present two cases of CL treated with ultrasound-guided infiltrations and ultrasound monitoring until resolution.
Clinical cases Case 1 A 61-year-old male was referred to our dermatology department because of a 3-month-old lesion on the upper left cheek. The lesion was initially treated with oral cloxacillin with no improvement. On physical examination, a
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