Topical pentostam in an attempt to produce more rapid healing of skin ulcers due to Leishmania braziliensis braziliensis.

We have already described the course of skin ulcers due to this parasite after intralesional Glucantime1. Because there appeared to be a slight response over 30 days we have extended our observations to the use of two topical preparations of Pentostam. These are the solution of Pentostam (Wellcome) inoculated intralesionally and Pentostam powder mixed with Aquaphor in the form of a cream. Once again we have compared the result of local treatment of one ulcer with an untreated lesion in the same patient with multiple ulcers. One third of our patient with initial cutaneous disease have such lesions in the area where we work3. The maximum (Rj) and minimum (R2 ) radius of the ulcer was measured and the area calculated using the formula: Ri x R2 x TT. Table 1 shows the results of intralesional Pen­ tostam 300mg Sbv daily for 10 days at the end of treatment in one patient and after 30 days later in two others. In terms of ulcer size no beneficiai effect was apparent during this time span although ulcers were often thought to be shallower. Unlike Glucantime Pentostam was not painful on local injection. Pentostam powder (15 grams) was mixed with 20 millilitres of water and 15 grams of Aquaphor to form a cream. This was applied in doses of 2 grams (600mg Sbv) daily to the surface of the ulcer for 5 or 10 days. Pupo6 reported favourable results using a 1% tartar emetic cream applied daily although he did not give data. Table 2 details treatment duration and results after varying periods of observations. Once again no beneficiai effect could be documented using the size of ulceration as a measurement and comparison with a control lesion. Tbree other patients (results not presented) were treated with Pentostam cream for single ulcers without visible effect. One of these patients developed erythema and pain on the sixth day of application which resolved on stopping the application. Since the results do not suggest any patient benefit we have suspended further investigations. Schmidt8 in 1950 was able to review an extensive