Concentrated Extracts of Cassia fistula Versus Intralesional Injection of Meglumine Antimoniate in Treatment of Acute Cutaneous Leishmaniasis

1 Background: Cutaneous leishmaniasis is an endemic disease in Iran. Although there are several treatment modalities for this disease, pentavalent antimonials are still considered as first line agents. There have beesn several reports concerning the effectiveness of Cassia fistula plant for leishmaniasis treatment. Objectives: This study was designed to assess the effectiveness of concentrated boiled and hydroalcoholic extracts of C. fistula on leishmaniasis lesions in comparison with intralesional injection of meglumine antimoniate (MA). Patients and Methods: In this randomized parallel clinical trial, 165 patients, 6-60 years old, with positive results of leishmaniasis smear tests were selected amongst the patients referred to the Skin Diseases and Leishmaniasis Research Center (SDLRC), Isfahan, Iran. They were randomly allocated to three groups for treatment with concentrated boiled extract of C. fistula , hydroalcoholic extract of C. fistula, and intralesional injection of MA. Patients were assessed at weeks one, two, three, four, and 16. Results of the treatment were reported as complete, partial, and no improvement. Results: complete resolution of the lesions at week 16 was observed in 22 (40%), 20 (36.4%), and 36 (65.5%) patients, in those treated with concentrated boiled extract of C. fistula , hydroalcoholic extract of C. fistula , and intralesional injection of MA, respectively. The efficacy of intralesional injection of MA was significantly more than concentrated boiled extract of the C. fistula application (P = 0.02). In addition, the efficacy of intralesional injection of MA was significantly more than hydroalcoholic extract of the C. fistula application (P = 0.005). There was no significant difference between the efficacy of concentrated boiled extract and the hydroalcoholic extract of the C. fistula (P = 0.61). Conclusions: Our study showed that almost 40% of the patients treated with C. fistula achieved complete resolution of the lesions. We recommend further evaluation of the effect of combined intralesional injection of MA and topical therapy with this plant, to assess the accelerating resolution of leishmaniasis lesions, and possibly decrease the applied dose of MA. Implication for health policy/practice/research/medical education: Cassia fistula has shown significantly better wound closure and tissue regeneration in treated rats, compared with controls. This potential could be contributed to its efficacy in CL lesions. Our study showed that almost 40% of patients treated with this plant were completely cured. This finding offered clinical evidence on the folkloric use of C. fistula extracts for treatment of cutaneous leishmaniasis. We propose further evaluation of concurrent topical use of this plant with MA to hasten resolution of leishmaniasis ulcer and possibly decrease the dose of MA. A complete phytochemical analysis is required to identify the active ingredients with potential contribution in the observed activity of C. fistula for treatment of cutaneous leishmaniasis.