Efficacy of cryotherapy plus topical Juniperus excelsa M. Bieb cream versus cryotherapy plus placebo in the treatment of Old World cutaneous leishmaniasis: A triple-blind randomized controlled clinical trial.

The short version

This triple-blind randomized controlled trial with 62 completing patients tested whether a cream made from Persian Juniper (Juniperus excelsa) leaf extract could improve treatment of cutaneous leishmaniasis (CL), a sand-fly-transmitted skin infection that causes slow-healing ulcers. Traditional Persian Medicine has described this exact condition for centuries, calling it "Rish-e-Balkhi" (Balkh sore), and prescribed Juniperus excelsa — known locally as Urs or Abhol — for infected, non-healing wounds long before modern medicine identified the parasite responsible. Researchers in Shiraz, Iran enrolled 72 adults with confirmed leishmania skin lesions and randomly assigned them to apply either a 5% Juniperus excelsa extract cream or a matching placebo cream three times a day, both combined with standard weekly freezing (cryotherapy) treatments, for up to 12 weeks. Lesions were measured weekly from photographs, and everyone was checked again 6 months later for any sign the infection had come back. The results were striking: 82% of patients using the Juniperus cream were completely cured, compared to just 34% on placebo — a difference far too large to be chance (p<0.001). The herbal-cream group also healed faster (about 6.5 weeks versus 8.7 weeks) and needed fewer freezing sessions to get there. Statistically, patients using the cream were about 13.5 times more likely to achieve a complete cure. None of the cured patients in either group saw their infection return over the following six months. Side effects were mild — about 15% of the cream group had temporary redness and itching after roughly five weeks, similar to rates in the placebo group, and only one person stopped using it (after already being cured). This traditional remedy, still cheap and easy to prepare today, appears to meaningfully boost cure rates and speed healing for cutaneous leishmaniasis when added to standard cryotherapy. Because every patient in the study also received cryotherapy, the cream's effect on its own — without freezing treatment — is still untested, and the trial excluded facial lesions and children. Larger studies, including one testing the cream by itself, would help confirm exactly how much of the benefit comes from the herb.

Key findings

• A cream made from Persian Juniper (Juniperus excelsa) leaves, used alongside standard cryotherapy freezing treatment, cured 82% of cutaneous leishmaniasis patients completely, compared to 34% who used a placebo cream with cryotherapy.
• Patients using the herbal cream also healed faster (about 6.5 weeks versus 8.7 weeks) and needed fewer freezing sessions to clear their infection.
• This plant has been used in Traditional Persian Medicine for centuries to treat this exact type of infected wound, described in historical texts as "Balkh sore."
• Side effects were mild and temporary, mainly some redness and itching, with no serious reactions reported.
• Because everyone in the study also received cryotherapy, it is not yet known how well the cream would work entirely on its own.

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