[Leish-l] Thermotherapy

[Anthony Bryceson]

This is for the guys in Bikaner.

In 1991 Jaideep Dogra, from your Department, published on dapsone in the treatment of CL

1. Dogra J. A double-blind study on the efficacy of oral dapsone in cutaneous leishmaniasis. Trans R Soc Trop Med Hyg. 1991;85:212-213.
He reported a cure rate of 82% at 6 weeks. 
It would be interesting to know if this work was taken any further?

Anthony Bryceson

On 15 Jun 2011, at 13:57, Richard Reithinger wrote:

>  
> For one of the patients:
>  
> Lancet. 2011 Feb 12;377(9765):610.
> Heat, Oriental sore, and HIV.
> Prasad N, Ghiya BC, Bumb RA, Kaushal H, Saboskar AA, Lezama-Davila CM, Salotra P, Satoskar AR.
>  
> 
> 
> --- On Wed, 15/6/11, Chang, Kwang-Poo <KwangPoo.Chang at rosalindfranklin.edu> wrote:
> 
> From: Chang, Kwang-Poo <KwangPoo.Chang at rosalindfranklin.edu>
> Subject: RE: Thermotherapy
> To: "Satoskar, Abhay" <Abhay.Satoskar at osumc.edu>, "Richard Reithinger" <rreithinger at yahoo.co.uk>, "John David" <jdavid at hsph.harvard.edu>, "Alan J COL MIL USA MEDCOM WRAIRMagill" <ALAN.MAGILL at US.ARMY.MIL>
> Cc: vishwamohan_katoch at yahoo.co.in, "Raj" <raj at cellabs.com.au>, leish-l at lineu.icb.usp.br
> Date: Wednesday, 15 June, 2011, 13:41
> 
> Dear Abhay,
>  
> Where are your HIV-CL patients located in India ? Are these PKDL or CL caused by something else ?
>  
> KP
> 
> From: Satoskar, Abhay [mailto:Abhay.Satoskar at osumc.edu]
> Sent: Wed 6/15/2011 6:33 AM
> To: Richard Reithinger; Chang, Kwang-Poo; John David; Alan J COL MIL USA MEDCOM WRAIRMagill
> Cc: vishwamohan_katoch at yahoo.co.in; Raj; leish-l at lineu.icb.usp.br
> Subject: RE: Thermotherapy
> 
> All,
> I think there some interesting discussions here. I think its worth trying anesthetic cream for heat therapy. We will do that. As Richard indicated that the greatest advantage of RF therapy ( even if it need local anesthesia with lidocaine) is that in most patient just one treatment for 1 min is enough to induce complete clinical cure. More importantly, in India we had three HIV patients with CL who failed to respond to intralesional SSG even after their CD4+ T cell counts increasing to > 200 after starting  HAART. These patients were treated with RF therapy which resulted in complete lesion healing  in 5-6 weeks. The patients have remained disease free after 1.5 years. As we know treating CL in HIV patients can be difficult so I think we have an effective alternative.
>  
> Abhay
>  
> Abhay R Satoskar MD, PhD
> Professor
> Departments of Pathology and Microbiology
> 129 Hamilton Hall
> 1645 Neil Avenue
> The Ohio State University
> Columbus, Ohio
> Tel: 614-366-3417
>  
> From: Richard Reithinger [rreithinger at yahoo.co.uk]
> Sent: Wednesday, June 15, 2011 4:02 AM
> To: Kwang-PooChang; John David; Alan J COL MIL USA MEDCOM WRAIRMagill
> Cc: Satoskar, Abhay; vishwamohan_katoch at yahoo.co.in; Raj; leish-l at lineu.icb.usp.br
> Subject: Thermotherapy
> 
>  
> All,
>  
> Agree with Alan: patients need at least intradermal anesthesia prior application of radiofrequency waves using the ThermoMed device; 50C is way to high for someone to endure for 5 min or so.
>  
> The reason the device appears to work better than other similar approaches is that the radiofrequencies yield a relatively homogenous/stable field where skin particles get excited, and in turn generate the heat; the heat (temperature) is then controlled by a thermistor embedded in the device. Following application of radiofrequency-generated heat, application of a topical antibiotic is recommended to avoid post-treatment secondary infections. From an operational point of view we also know that the ThermoMed device is more useful in situations where (i) you have lots of patients (i.e. economies of scale); (ii) patients with smaller lesions; and (iii) patient with lesions that are not located on joint or body areas that are difficult to access. Whilst a clear disadvantage of the device has been cost, the advantages have been that many patients only require one application session of radiofrequency-generated heat (i.e. patient lost to follow-up are not an issue) and that the device is portable (e.g. can be used in mobile-type of treatment service provision).
>  
> Having said, I second Tony Bryceson's comment, that there is scope for additional well-designed and carried out clinical trials looking at this approach, comparing it to IM/IV or IL SbV or other treatment modalities.
>  
> Richard Reithinger
> 
> --- On Wed, 8/6/11, Magill, Alan J COL MIL USA MEDCOM WRAIR <ALAN.MAGILL at US.ARMY.MIL> wrote:
> 
> From: Magill, Alan J COL MIL USA MEDCOM WRAIR <ALAN.MAGILL at US.ARMY.MIL>
> Subject: Re: [Leish-l] inquiry
> To: "Chang, Kwang-Poo" <KwangPoo.Chang at rosalindfranklin.edu>, "John David" <jdavid at hsph.harvard.edu>
> Cc: "Satoskar, Abhay" <Abhay.Satoskar at osumc.edu>, "vishwamohan_katoch at yahoo.co.in" <vishwamohan_katoch at yahoo.co.in>, "Raj" <raj at cellabs.com.au>, "leish-l at lineu.icb.usp.br" <leish-l at lineu.icb.usp.br>
> Date: Wednesday, 8 June, 2011, 20:45
> 
> John certainly knows well..
> 
> 50C is not tolerable to human skin. All potential lesions to be treated need to be appropriately cleaned and anesthetized with intradermal and subQ injection of lidocaine. I have never tried the newer lidocaine creams such as EMLA, they might work as well. This can be somewhat rate limiting for multiple lesions as each lesion needs to be prepared, injected, and you need to wait about 10 plus minutes for the lidocaine to work.
> 
> Trying the Thermomed device on normal skin (try on yourself) will show that most people can only get to about 43 or 44 C before quickly removing the device from their skin.
> 
> Alan Magill
> 
> 
> ________________________________
> From: leish-l-bounces at lineu.icb.usp.br [leish-l-bounces at lineu.icb.usp.br] On Behalf Of Chang, Kwang-Poo [KwangPoo.Chang at rosalindfranklin.edu]
> Sent: Monday, June 06, 2011 12:02 PM
> To: John David
> Cc: Satoskar, Abhay; vishwamohan_katoch at yahoo.co.in; Raj; leish-l at lineu.icb.usp.br
> Subject: Re: [Leish-l] inquiry
> 
> Any chance to make it available for additional trials elsewhere ?
> 
> I recall your statement in our conversation about the advantage of this instrument over the heating lamp. That is to maintain the specific elevated temperature uniformly throughout the skin lesion for a sustained period. The 50 C must be the effective temperature that has been experimentally determined. It seems to be a tolerable temperature to human skin ?  Dr. Sharma may comment on this medically as a dermatologist ?
> 
> KP
> 
> ________________________________
> From: John David [mailto:jdavid at hsph.harvard.edu]
> Sent: Sunday, June 05, 2011 11:18 PM
> To: Chang, Kwang-Poo
> Cc: Sharmanl; Satoskar, Abhay; Raj; Petr Volf; leish-l at lineu.icb.usp.br; hgoto at usp.br; elfadil_abass at yahoo.com; vishwamohan_katoch at yahoo.co.in
> Subject: Re: [Leish-l] inquiry
> 
> The Themomed instrument shown below can produce accurate 50 degrees C  plus or minus 0.2 degrees temperature by radio wave.
> from Themorsurgery Technologies. Picture below.
> Two papers of a trial in Brazil and one in Afghanistan on CL below.
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