The Efficacy of Topical Treatment of Concentrated Boiled Extract and Hydroalcoholic Extract of Cassia Fistula in Comparison to the Intralesional Injection of Meglumine Antimoniate in the Treatment of Acute Cutaneous Leishmaniasis

Background: Cutaneous leishmaniasis is an endemic disease in Iran. Although there are several treatment modalities for this disease, pentavalent antimonials still are considered as first line treatment. There have been a number of different reports on the effectiveness of Cassia fistula plant in the treatment of leishmaniasis. This study was designed to assess the effectiveness of concentrated boiled extract and hydroalcoholic extract of Cassia fistula on leishmaniasis lesions compared to intralesional injection of meglumine antimoniate (MA). Methods: In this randomized parallel clinical trial, 165 patients of 6-60 year-old with positive leishmaniasis smear test were selected out of the patients referred to the Skin Diseases and Leishmaniasis Research Center (SDLRC). They were divided into three groups for treatment with concentrated boiled extract of Cassia Fistula, hydroalcoholic extract of Cassia fistula and intralesional injection of MA. The patients were assessed at week 1, 2, 3, 4, and week 16. The results of the treatment were reported as complete improvement, partial improvement and no improvement. Results: Numbers of the patients that achieved complete cure at week 16 were 22 patients (40%), 20 patients (36.4%) and 36 patients (65.5%) for concentrated boiled extract of Cassia fistula, hydroalcoholic extract of Cassia fistula and intralesional injection of MA, respectively. The efficacy of the intralesional injection of MA was significantly more than that of the concentrated boiled extract of the Cassia fistula (P = 0.02). Also, the efficacy of the intralesional injection of MA was significantly more than that of the hydroalcoholic extract of the Cassia fistula (P = 0.005). There was no significant difference between the efficacy of concentrated boiled extract and that of the hydroalcoholic extract of the Cassia fistula (P = 0.61). Conclusion: Our study showed that almost 40% of the patients treated with this plant achieved complete cure of the lesions. We propose further evaluation of the effect of combined intralesional injection of MA and topical therapy with this plant to assess the accelerating resolution of the leishmaniasis ulcer and to possibly decrease the dose of MA. Key words: Cutaneous leishmaniasis, Cassia fistula, Meglumine antimoniate.