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Fernando I, K Edwards S, Grover D. British Association for Sexual Health and HIV national guideline for the management of Genital Molluscum in adults (2021). Int J STD AIDS 2022; 33:422-432. [PMID: 35312417 DOI: 10.1177/09564624211070705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This guideline offers recommendations on diagnosis, treatment regimens and health promotion principles needed for the effective management of genital molluscum, including management of the initial presentation and recurrences. The Primary focus of the guideline is on infection which affects the genital area and has a sexual mode of transmission. This is an update to the guideline previously published in this journal in 2014.
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Affiliation(s)
| | - Sarah K Edwards
- GU Medicine, 215332Cambridgeshire Community Services NHS Trust, Bury St Edmunds, UK
| | - Deepa Grover
- GUM/HIV Medicine, 4954Central and North West London NHS Foundation Trust, London, UK
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2
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Heo JY, Park TH, Kim WI. The efficacy and safety of topical 10% potassium hydroxide for molluscum contagiosum: a systematic review and meta-analysis. J DERMATOL TREAT 2021; 33:1682-1690. [PMID: 33667150 DOI: 10.1080/09546634.2021.1898527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Molluscum contagiosum (MC) is a self-limited cutaneous viral infection. Topical 10% potassium hydroxide (KOH) has been used for treating MC. However, it remains unclear whether it is beneficial or not to apply topical 10% KOH for treating MC. METHODS To confirm the efficacy and safety of topical 10% KOH compared with placebo as well as other treatments for MC, meta-analysis was used. Up to September 2020, we performed a comprehensive search of literature based on three databases with following keywords including 'molluscum contagiosum' and 'potassium hydroxide'. RESULTS Our meta-analyses demonstrated a significant difference between topical 10% KOH and placebo for complete clearance of MC (RR: 2.96, 95% CI: 1.69 - 5.17, p = .0001), while there were no statistical differences between them in the number of patients with adverse events (RR: 1.73, 95% CI: 0.67 - 4.45, p = .2562). Also, topical 10% KOH was as effective as mechanical treatments for MC (RR: 0.95, 95% CI: 0.84 - 1.07, p = .3833). CONCLUSION We demonstrate that application of topical 10% KOH may be one of effective and appropriate methods for the treatment of MC compared with awaiting spontaneous resolution due to its safety and effectiveness.
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Affiliation(s)
- Jae Young Heo
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Tae Heum Park
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Woo Il Kim
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
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3
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Verma SB. Anetoderma in molluscum contagiosum treated with 10% potassium hydroxide. Australas J Dermatol 2021; 62:e475-e476. [PMID: 34129233 DOI: 10.1111/ajd.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
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4
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DI Brizzi EV, Russo T, Alfano R, Argenziano G, Piccolo V. Abnormal cutaneous reaction to potassium hydroxide in molluscum contagiosum in children. Ital J Dermatol Venerol 2020; 157:104-105. [PMID: 33070569 DOI: 10.23736/s2784-8671.20.06653-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Teresa Russo
- Dermatology Unit, University of Campania, Naples, Italy
| | - Roberto Alfano
- Department of Anesthesiology Surgery and Emergency, University of Campania, Naples, Italy
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Edwards S, Boffa MJ, Janier M, Calzavara-Pinton P, Rovati C, Salavastru CM, Rongioletti F, Wollenberg A, Butacu AI, Skerlev M, Tiplica GS. 2020 European guideline on the management of genital molluscum contagiosum. J Eur Acad Dermatol Venereol 2020; 35:17-26. [PMID: 32881110 DOI: 10.1111/jdv.16856] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 01/05/2023]
Abstract
Molluscum contagiosum is a benign viral epidermal infection associated with high risk of transmission. The guideline is focused on the sexually transmitted molluscum contagiosum. The diagnosis is clinical with characteristic individual lesions, termed 'mollusca', seen as dome-shaped, smooth-surfaced, pearly, firm, skin-coloured, pink, yellow or white papules, 2 - 5 mm in diameter with central umbilication. Dermoscopy may facilitate diagnosis. Therapeutic options are numerous, including physical treatments (cautery, curettage and cryotherapy), topical chemical treatments (e.g. podophyllotoxin and imiquimod) or waiting for spontaneous resolution in immunocompetent patients. In pregnancy, it is safe to use physical procedures (e.g. cryotherapy). Immunosuppressed patients develop severe and recalcitrant molluscum lesions that may require treatment with cidofovir, imiquimod or interferon. Patients with molluscum contagiosum infection should be offered to be screened for other sexually transmitted infections.
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Affiliation(s)
| | - M J Boffa
- Department of Dermatology, Sir Paul Boffa Hospital, Floriana, Malta
| | - M Janier
- STD Clinic, Hôpital Saint-Louis AP-HP and Hôpital Saint-Joseph, Paris, France
| | | | - C Rovati
- Dermatology Department, University of Brescia, Italy
| | - C M Salavastru
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Wollenberg
- Dept. of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - A I Butacu
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - M Skerlev
- Zagreb University Hospital and Zagreb University School Of Medicine, Zagreb, Croatia
| | - G S Tiplica
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
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6
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Giner-Soriano M, Teixidó C, Marsal JR, Díez O, Pera H, Vlacho B, Morros R. Randomized placebo-controlled clinical trial on efficacy and safety of topical 10% Potassium hydroxide for molluscum contagiosum treatment in children. J DERMATOL TREAT 2019; 30:750-756. [PMID: 30668179 DOI: 10.1080/09546634.2019.1573305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Our objective was to assess efficacy, safety and tolerance of topical potassium hydroxide (KOH) 10% for treating Molluscum contagiosum (MC) in children. Material and methods: Randomized, double-blind, placebo-controlled clinical trial including all children 2-16 years with MC infection attending pediatrician primary healthcare visits. The treatment was KOH 10% gel applied once daily up to clearing (maximum 30 days). Results: KOH 10% showed superior efficacy to placebo (55.3% vs 16.3%, p < .001). Time until clearing was inferior with KOH 10% (p = .001). MC lesions were reduced with KOH 10%, which also showed higher efficacy when the instructions of use of the device were modified. KOH 10% patients presented more adverse events (AE) than placebo patients (72.3% vs 31.8%, p < .001). Most patients (91.5%) completely recovered. There were no differences in frequency of AE before and after the change of instructions, intolerance was more frequently reported by parents with new instructions. Conclusions: KOH 10% was superior to placebo in the main efficacy outcome and most secondary efficacy outcomes. KOH 10% patients had more AE and intolerance symptoms than placebo, although there were no severe AE and most patients recovered. KOH 10% is an effective and safe topical treatment for MC infection in children.
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Affiliation(s)
- Maria Giner-Soriano
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol) , Barcelona , Spain.,Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallès) , Spain.,Institut Català de la Salut , Barcelona , Spain
| | - Concepció Teixidó
- Centre d'Atenció Primària 1er de maig , Institut Català de la Salut , Lleida , Spain
| | - Josep R Marsal
- Unitat de Suport a la Recerca Lleida, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol) , Lleida , Spain.,Unitat d'Epidemiologia del Servei de Cardiologia, Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Olga Díez
- Centro de Salud Casablanca , Zaragoza , Spain
| | - Helena Pera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol) , Barcelona , Spain.,Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallès) , Spain
| | - Bogdan Vlacho
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol) , Barcelona , Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP) , Badalona , Spain
| | - Rosa Morros
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol) , Barcelona , Spain.,Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallès) , Spain.,Institut Català de la Salut , Barcelona , Spain
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7
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Gerlero P, Hernández-Martín Á. Actualización sobre el tratamiento de moluscos contagiosos en los niños. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:408-415. [DOI: 10.1016/j.ad.2018.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/20/2017] [Accepted: 01/18/2018] [Indexed: 11/25/2022] Open
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9
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Teixidó C, Díez O, Marsal JR, Giner-Soriano M, Pera H, Martinez M, Galindo-Ortego G, Schoenenberger JA, Real J, Cruz I, Morros R. Efficacy and safety of topical application of 15% and 10% potassium hydroxide for the treatment of Molluscum contagiosum. Pediatr Dermatol 2018; 35:336-342. [PMID: 29479727 DOI: 10.1111/pde.13438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Molluscum contagiosum is the most common skin infection in children. One topical treatment used for Molluscum contagiosum is potassium hydroxide. The objective of this study was to compare the efficacy of potassium hydroxide topical treatment at different concentrations with that of placebo in terms of complete clearing of Molluscum contagiosum lesions and to assess the safety and tolerance of potassium hydroxide topical treatment. METHODS This was a double-blind randomized clinical trial of three treatments (potassium hydroxide 10%, potassium hydroxide 15%, placebo) applied once daily up to complete clearing of lesions (maximum duration 60 days) in 53 children aged 2-6 years in primary health care pediatric offices in Catalonia, Spain. RESULTS In the intention-to-treat analysis, potassium hydroxide 10% (58.8%, P = .03) and potassium hydroxide 15% (64.3%, P = .02) had efficacy superior to that of placebo (18.8%). The number of Molluscum contagiosum lesions was significantly reduced with potassium hydroxide 10% and 15%. The main efficacy outcome was achieved in 58.8% of children in the potassium hydroxide 10% group (P = .03 vs placebo) and in 64.3% of children in the potassium hydroxide 15% group (P = .02 vs placebo). Potassium hydroxide 10% and 15% were not significantly different in efficacy from each other. Potassium hydroxide 10% and placebo were better tolerated than potassium hydroxide 15%. No adverse events were reported during the study period. CONCLUSIONS Potassium hydroxide 10% and 15% demonstrated high rates of efficacy in clearing Molluscum contagiosum lesions, with potassium hydroxide 10% being better tolerated.
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Affiliation(s)
- Concepció Teixidó
- Centre d'Atenció Primària Rambla Ferran, Institut Català de la Salut, Lleida, Spain
| | - Olga Díez
- Centro de Salud Casablanca, Zaragoza, Spain
| | - Josep R Marsal
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Unitat de Suport a la Recerca Lleida, Lleida, Spain.,Unitat d'Epidemiologia del Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Giner-Soriano
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Institut Català de la Salut, Barcelona, Spain
| | - Helena Pera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Unidad de Investigación Clínica y Ensayos Clínicos, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Mireia Martinez
- Pharmacy Unit, Institut de Recerca Biomèdica de Lleida, University Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Joan A Schoenenberger
- Pharmacy Unit, Institut de Recerca Biomèdica de Lleida, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Jordi Real
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Epidemiologia i Salut Pública, Universitat Internacional de Catalunya, Sant Cugat, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Ines Cruz
- Centre d'Atenció Primària Rambla Ferran, Institut Català de la Salut, Lleida, Spain
| | - Rosa Morros
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Institut Català de la Salut, Barcelona, Spain
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10
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van der Wouden JC, van der Sande R, Kruithof EJ, Sollie A, van Suijlekom‐Smit LWA, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev 2017; 5:CD004767. [PMID: 28513067 PMCID: PMC6481355 DOI: 10.1002/14651858.cd004767.pub4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Molluscum contagiosum is a common skin infection that is caused by a pox virus and occurs mainly in children. The infection usually resolves within months in people without immune deficiency, but treatment may be preferred for social and cosmetic reasons or to avoid spreading the infection. A clear evidence base supporting the various treatments is lacking.This is an update of a Cochrane Review first published in 2006, and updated previously in 2009. OBJECTIVES To assess the effects of specific treatments and management strategies, including waiting for natural resolution, for cutaneous, non-genital molluscum contagiosum in people without immune deficiency. SEARCH METHODS We updated our searches of the following databases to July 2016: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched six trial registers and checked the reference lists of included studies and review articles for further references to relevant randomised controlled trials. We contacted pharmaceutical companies and experts in the field to identify further relevant randomised controlled trials. SELECTION CRITERIA Randomised controlled trials of any treatment of molluscum contagiosum in people without immune deficiency. We excluded trials on sexually transmitted molluscum contagiosum and in people with immune deficiency (including those with HIV infection). DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed methodological quality, and extracted data from selected studies. We obtained missing data from study authors where possible. MAIN RESULTS We found 11 new studies for this update, resulting in 22 included studies with a total of 1650 participants. The studies examined the effects of topical (20 studies) and systemic interventions (2 studies).Among the new included studies were the full trial reports of three large unpublished studies, brought to our attention by an expert in the field. They all provided moderate-quality evidence for a lack of effect of 5% imiquimod compared to vehicle (placebo) on short-term clinical cure (4 studies, 850 participants, 12 weeks after start of treatment, risk ratio (RR) 1.33, 95% confidence interval (CI) 0.92 to 1.93), medium-term clinical cure (2 studies, 702 participants, 18 weeks after start of treatment, RR 0.88, 95% CI 0.67 to 1.14), and long-term clinical cure (2 studies, 702 participants, 28 weeks after start of treatment, RR 0.97, 95% CI 0.79 to 1.17). We found similar but more certain results for short-term improvement (4 studies, 850 participants, 12 weeks after start of treatment, RR 1.14, 95% CI 0.89 to 1.47; high-quality evidence). For the outcome 'any adverse effect', we found high-quality evidence for little or no difference between topical 5% imiquimod and vehicle (3 studies, 827 participants, RR 0.97, 95% CI 0.88 to 1.07), but application site reactions were more frequent in the groups treated with imiquimod (moderate-quality evidence): any application site reaction (3 studies, 827 participants, RR 1.41, 95% CI 1.13 to 1.77, the number needed to treat for an additional harmful outcome (NNTH) was 11); severe application site reaction (3 studies, 827 participants, RR 4.33, 95% CI 1.16 to 16.19, NNTH over 40).For the following 11 comparisons, there was limited evidence to show which treatment was superior in achieving short-term clinical cure (low-quality evidence): 5% imiquimod less effective than cryospray (1 study, 74 participants, RR 0.60, 95% CI 0.46 to 0.78) and 10% potassium hydroxide (2 studies, 67 participants, RR 0.65, 95% CI 0.46 to 0.93); 10% Australian lemon myrtle oil more effective than olive oil (1 study, 31 participants, RR 17.88, 95% CI 1.13 to 282.72); 10% benzoyl peroxide cream more effective than 0.05% tretinoin (1 study, 30 participants, RR 2.20, 95% CI 1.01 to 4.79); 5% sodium nitrite co-applied with 5% salicylic acid more effective than 5% salicylic acid alone (1 study, 30 participants, RR 3.50, 95% CI 1.23 to 9.92); and iodine plus tea tree oil more effective than tea tree oil (1 study, 37 participants, RR 0.20, 95% CI 0.07 to 0.57) or iodine alone (1 study, 37 participants, RR 0.07, 95% CI 0.01 to 0.50). Although there is some uncertainty, 10% potassium hydroxide appears to be more effective than saline (1 study, 20 participants, RR 3.50, 95% CI 0.95 to 12.90); homeopathic calcarea carbonica appears to be more effective than placebo (1 study, 20 participants, RR 5.57, 95% CI 0.93 to 33.54); 2.5% appears to be less effective than 5% solution of potassium hydroxide (1 study, 25 participants, RR 0.35, 95% CI 0.12 to 1.01); and 10% povidone iodine solution plus 50% salicylic acid plaster appears to be more effective than salicylic acid plaster alone (1 study, 30 participants, RR 1.43, 95% CI 0.95 to 2.16).We found no statistically significant differences for other comparisons (most of which addressed two different topical treatments). We found no randomised controlled trial evidence for expressing lesions or topical hydrogen peroxide.Study limitations included no blinding, many dropouts, and no intention-to-treat analysis. Except for the severe application site reactions of imiquimod, none of the evaluated treatments described above were associated with serious adverse effects (low-quality evidence). Among the most common adverse events were pain during application, erythema, and itching. Included studies of the following comparisons did not report adverse effects: calcarea carbonica versus placebo, 10% povidone iodine plus 50% salicylic acid plaster versus salicylic acid plaster, and 10% benzoyl peroxide versus 0.05% tretinoin.We were unable to judge the risk of bias in most studies due to insufficient information, especially regarding concealment of allocation and possible selective reporting. We considered five studies to be at low risk of bias. AUTHORS' CONCLUSIONS No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. We found moderate-quality evidence that topical 5% imiquimod was no more effective than vehicle in terms of clinical cure, but led to more application site reactions, and high-quality evidence that there was no difference between the treatments in terms of short-term improvement. However, high-quality evidence showed a similar number of general side effects in both groups. As the evidence found did not favour any one treatment, the natural resolution of molluscum contagiosum remains a strong method for dealing with the condition.
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Affiliation(s)
- Johannes C van der Wouden
- VU University Medical CenterDepartment of General Practice and Elderly Care Medicine, Amsterdam Public Health Research InstitutePO Box 7057AmsterdamNetherlands1007 MB
| | - Renske van der Sande
- Erasmus Medical CenterDepartment of General PracticePO Box 2040Room Ff303RotterdamNetherlands3000 CA
| | - Emma J Kruithof
- VU University Medical CenterDepartment of General Practice and Elderly Care Medicine, Amsterdam Public Health Research InstitutePO Box 7057AmsterdamNetherlands1007 MB
| | - Annet Sollie
- Maison Medical Bel Air154 Avenue Bel AirCarpentrasFrance1084200
| | - Lisette WA van Suijlekom‐Smit
- Erasmus Medical Center ‐ Sophia Children's HospitalDepartment of Paediatrics, Paediatric RheumatologyPO Box 2060RotterdamNetherlands3000 CB
| | - Sander Koning
- Erasmus Medical CenterDepartment of General PracticePO Box 2040Room Ff303RotterdamNetherlands3000 CA
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Abstract
PURPOSE OF REVIEW Warts and molluscum contagiosum are very common viral skin infections, usually presenting in childhood. Despite the large number of people affected by them, high-quality trials of treatment are few and treatment is often chosen on the basis of cost, convenience and tradition. RECENT FINDINGS Over recent years, two further trials of the most commonly used treatments for warts, salicylic acid and cryotherapy, have been performed and for molluscum contagiosum, there is growing evidence for the use of irritants. For both infections, there are new evaluations of immunological approaches to therapy. SUMMARY Strong, high-quality evidence for treatments used very frequently for warts or molluscum is still lacking, but recent publications have helped to strengthen or weaken belief in commonly used therapies and to add weight to the immunological approach to management.
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Al-Sudany NK, Abdulkareem DR. A comparative study of topical 10% KOH solution and topical 25% podophyllin solution as home-based treatments of molluscum contagiosum. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2016. [DOI: 10.1016/j.jdds.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Chathra N, Sukumar D, Bhat RM, Kishore BN, Martis J, Kamath G, Srinath MK, Monteiro R. A comparative study of 10% KOH solution and 5% imiquimod cream for the treatment of Molluscum contagiosum in the pediatric age group. Indian Dermatol Online J 2015; 6:75-80. [PMID: 25821725 PMCID: PMC4375769 DOI: 10.4103/2229-5178.153005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Although Molluscum contagiosum (MC) is a self-limiting condition, active therapy could prevent further spread and improve cosmesis. Most of the available treatment modalities traumatize the lesions and have to be undertaken in the hospital, therefore evoking panic in children. In the quest for an alternative therapy, this study comparing 10% potassium hydroxide (KOH) solution and 5% imiquimod cream was taken up. Aims and Objectives: To compare the efficacy and tolerability of 10% KOH and 5% imiquimod in the treatment of MC. Materials and Methods: This comparative study was conducted over a period of 18 months from October 2011 to March 2013, 40 patients between the age group of 1-18 years with clinically diagnosed MC were divided into two groups (lottery method), 20 patients were treated with 5% imiquimod cream (Group A) and the other 20 were treated with 10% KOH solution (Group B). Patients were followed up on the 4th, 8th and 12th week of treatment. Results: At the end of 12 weeks, out of 20 patients who received 10% KOH, 17 patients showed complete disappearance, whereas out of 20 patients who received 5% imiquimod, only 10 patients showed total clearance of the lesions. Adverse events were more frequent with 10% KOH, pigmentary disturbances being the most common. Conclusion: With only minor adverse effects, 10% KOH is an inexpensive and efficient modality for the treatment of MC in the pediatric age group. Although 5% imiquimod was effective in clearing the lesions with minimal adverse effects, the longer duration required for its efficacy may deter its wider use.
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Affiliation(s)
- Namitha Chathra
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College and Hospital, Kankanady, Mangalore, Karnataka, India
| | - D Sukumar
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College and Hospital, Kankanady, Mangalore, Karnataka, India
| | - Ramesh M Bhat
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College and Hospital, Kankanady, Mangalore, Karnataka, India
| | - B Nanda Kishore
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College and Hospital, Kankanady, Mangalore, Karnataka, India
| | - Jacintha Martis
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College and Hospital, Kankanady, Mangalore, Karnataka, India
| | - Ganesh Kamath
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College and Hospital, Kankanady, Mangalore, Karnataka, India
| | - M K Srinath
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College and Hospital, Kankanady, Mangalore, Karnataka, India
| | - Rochelle Monteiro
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College and Hospital, Kankanady, Mangalore, Karnataka, India
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Fernando I, Pritchard J, Edwards SK, Grover D. UK national guideline for the management of Genital Molluscum in adults, 2014 Clinical Effectiveness Group, British Association for Sexual Health and HIV. Int J STD AIDS 2014; 26:687-95. [PMID: 25332225 DOI: 10.1177/0956462414554435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Jill Pritchard
- Sexual Health Ashford and St Peter's Hospital, Chertsey, Surrey, UK
| | - Sarah K Edwards
- Sexual Health Cambridgeshire Community Services, Cambridgeshire, UK
| | - Deepa Grover
- Barnet General Hospital, Hertfordshire, UK Royal Free Hospital, London, UK
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15
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Camargo CLDA, Belda Junior W, Fagundes LJ, Romiti R. A prospective, open, comparative study of 5% potassium hydroxide solution versus cryotherapy in the treatment of genital warts in men. An Bras Dermatol 2014; 89:236-40. [PMID: 24770498 PMCID: PMC4008052 DOI: 10.1590/abd1806-4841.20141702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/05/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Genital warts are caused by human papillomavirus infection and represent one of
the most common sexually transmitted diseases. Many infections are transient but
the virus may recur, persist, or become latent. To date, there is no effective
antiviral treatment to eliminate HPV infection and most therapies are aimed at the
destruction of visible lesions. Potassium hydroxide is a strong alkali that has
been shown to be safe and effective for the treatment of genital warts and
molluscum contagiosum. Cryotherapy is considered one of the most established
treatments for genital warts. No comparative trials have been reported to date on
the use of potassium hydroxide for genital warts. OBJECTIVE A prospective, open-label, randomized clinical trial was conducted to compare
topical potassium hydroxide versus cryotherapy in the treatment of genital warts
affecting immunocompetent, sexually active men. METHODS Over a period of 10 months, 48 patients were enrolled. They were randomly divided
into two groups and selected on an alternative basis for either potassium
hydroxide therapy or cryotherapy. While response to therapy did not differ
substantially between both treatment modalities, side effects such as local pain
and post-treatment hypopigmentation were considerably more prevalent in the groups
treated using cryotherapy. RESULT In our study, potassium hydroxide therapy proved to be at least as effective as
cryotherapy and offered the benefit of a better safety profile. CONCLUSION Topical 5% potassium hydroxide presents an effective, safe, and low-cost treatment
modality for genital warts in men and should be included in the spectrum of
therapies for genital warts.
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Işik S, Koca R, Sarici G, Altinyazar HC. A comparison of a 5% potassium hydroxide solution with a 5-fluorouracil and salicylic acid combination in the treatment of patients with anogenital warts: a randomized, open-label clinical trial. Int J Dermatol 2014; 53:1145-50. [PMID: 25039244 DOI: 10.1111/ijd.12505] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Anogenital warts are caused by human papillomavirus (HPV), over 30 types of which are infectious for the anogenital tract. Without treatment, warts may regress spontaneously, remain unchanged, or increase in number and size. This study compared the efficacy of a topical 5% potassium hydroxide (KOH) solution with that of a topical 0.5% 5-fluorouracil (5-FU) and 10% salicylic acid (SA) combination in the treatment of anogenital warts. Sixty patients were randomly assigned to receive topical KOH or 5-FU + SA. Both groups demonstrated a significant decrease in numbers of lesions (P < 0.05), but this difference was not significant at week 12 (P > 0.05). The mean number of lesions decreased from baseline to week 12 from 17.03 ± 12.64 to 3.73 ± 7.30 and from 16.13 ± 12.97 to 3.10 ± 4.90 in the KOH and 5-FU + SA groups, respectively (P < 0.001). Excellent clearance was achieved by 70.0 and 76.7% of patients in the KOH and 5-FU + SA groups, respectively. Marked improvement was seen in 13.3 and 20.0% of patients in the KOH and 5-FU + SA groups, respectively. At week 16, relapse was observed in two patients in the KOH group and three in the 5-FU + SA group (P > 0.05). No serious adverse events were reported. Neither treatment was more efficacious. Safety and ease of application are important goals in treatments for anogenital warts. A 5% KOH solution is a promising alternative treatment because it is effective and inexpensive and causes minimal side effects.
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Affiliation(s)
- Selda Işik
- Department of Dermatology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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Handjani F, Behazin E, Sadati MS. Comparison of 10% potassium hydroxide solution versus cryotherapy in the treatment of molluscum contagiosum: an open randomized clinical trial. J DERMATOL TREAT 2013; 25:249-50. [PMID: 23924070 DOI: 10.3109/09546634.2013.832135] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Molluscum contagiosum (MC) is a common cutaneous viral infection. Potassium hydroxide (KOH), as a strong alkali, and cryotherapy have been used for its treatment. The objective of this study was to compare these two treatment modalities. METHODS 30 patients, aged between 1 and 24 years of age, were randomly divided into 2 groups: 15 were treated with KOH 10% solution and 15 were treated with cryotherapy. KOH 10 % was applied by the patient or their parent(s) two times a day until the lesions disappeared completely. Cryotherapy was performed with liquid nitrogen spray, repeated weekly for 4 weeks. The assessment of response and side effects were performed weekly for 4 weeks. RESULTS In the KOH group, 86.6% had complete response, 6.7% had partial response and 6.7% had no response after 4 weeks. In the cryotherapy group, 93.3% had complete response and 6.7% had partial response. There was no statistically significant difference between the two groups (p > 0.05). Postinflammatory hyperpigmentation, as a side effect, was mostly noted with cryotherapy. CONCLUSION Both treatment modalities were equally effective. Since KOH is inexpensive and confers better cosmetic results compared to cryotherapy, it can be used as a suitable treatment modality for MC.
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Affiliation(s)
- Farhad Handjani
- Department of Dermatology, Molecular Dermatology Research Center, Faghihi Hospital, Shiraz University of Medical Sciences , Shiraz , Iran
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Chen X, Anstey AV, Bugert JJ. Molluscum contagiosum virus infection. THE LANCET. INFECTIOUS DISEASES 2013; 13:877-88. [PMID: 23972567 DOI: 10.1016/s1473-3099(13)70109-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Molluscum contagiosum virus is an important human skin pathogen: it can cause disfigurement and suffering in children, in adults it is less common and often sexually transmitted. Extensive and persistent skin infection with the virus can indicate underlying immunodeficiency. Traditional ablative therapies have not been compared directly with newer immune-modulating and specific antiviral therapies. Advances in research raise the prospect of new approaches to treatment informed by the biology of the virus; in human skin, the infection is localised in the epidermal layers, where it induces a typical, complex hyperproliferative lesion with an abundance of virus particles but a conspicuous absence of immune effectors. Functional studies of the viral genome have revealed effects on cellular pathways involved in the cell cycle, innate immunity, inflammation, and cell death. Extensive lesions caused by molluscum contagiosum can occur in patients with DOCK8 deficiency-a genetic disorder affecting migration of dendritic and specialised T cells in skin. Sudden disappearance of lesions is the consequence of a vigorous immune response in healthy people. Further study of the unique features of infection with molluscum contagiosum virus could give fundamental insight into the nature of skin immunity.
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Affiliation(s)
- Xiaoying Chen
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Uçmak D, Akkurt MZ, Kacar SD, Sula B, Arica M. Comparative study of 5% and 2.5% potassium hydroxide solution for molluscum contagiosum in children. Cutan Ocul Toxicol 2013; 33:54-9. [PMID: 23713782 DOI: 10.3109/15569527.2013.796479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Molluscum contagiosum (MC) is a pediatric viral infection that is fairly contagious. Although various treatment methods are available, the presence of facial lesions limits options of therapy. AIM We aimed to test an alternative treatment consisting of application of two different concentrations of potassium hydroxide (of KOH 5% solution and of KOH 2.5% solution) aqueous solution. METHODS In this study we evaluated the effectiveness and side-effects of daily applications of potassium hydroxide (KOH) aqueous solution at 2.5% and 5% concentrations, twice daily in 29 children with MC. Out of a total of 29 patients with molluscum contagiosum included in the study, 13 patients in the 2.5% KOH group and 12 patients in the KOH 5% group completed the study. Families were instructed to apply potassium hydroxide twice a day. The assessment of response and side-effects were performed on days 0, 15, 30, 45 and 60 (visits were numbered 1, 2, 3, 4 and 5, respectively) and one month after. RESULTS We had a total of 11 (44%) patients who completely recovered after the fifth visit. While eight (66.7%) of these 11 patients were in the 5% treatment group, three (23.1%) patients were in the 2.5% treatment group, and there was a statistically meaningful difference (p < 0.047). Patients with fewer lesions remitted better (p < 0.05). When number of lesions were taken into consideration, difference between the two treatment groups appeared after the fourth visit (p < 0.001). There were no statistical differences between the two groups with respect to side-effects (p = 0.682). CONCLUSIONS Potassium hydroxide solution at a concentration of 5% was more effective than 2.5% in our patients. The treatment was well-tolerated on the face with the advantage of administration of lower concentrations. This study suggests potassium hydroxide may be a more preferable mode of treatment for molluscum contagiosum lesions on the face.
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Affiliation(s)
- Derya Uçmak
- Department of Dermatology, Dicle University , Diyarbakir , Turkey and
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20
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Lymphogranuloma Venereum, Chancroid, Granuloma Inguinale, and Molluscum Contagiosum. Sex Transm Dis 2013. [DOI: 10.1007/978-1-62703-499-9_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Can B, Topaloğlu F, Kavala M, Turkoglu Z, Zindancı I, Sudogan S. Treatment of pediatric molluscum contagiosum with 10% potassium hydroxide solution. J DERMATOL TREAT 2012; 25:246-8. [PMID: 22639976 DOI: 10.3109/09546634.2012.697988] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Molluscum contagiosum (MC) is a common cutaneous viral infection of the skin that is frequently seen in children. Although lesions can resolve spontaneously, treatment is mandatory because of the psychological effect of widespread lesions in children. Potassium hydroxide (KOH) is a strong alkali that has been used by dermatologists for a long time in identifying the fungal infections from skin scrapings. AIMS We evaluated 40 children with MC for the safety and efficacy of treatment with topical 10% KOH aqueous solution. METHODS Parents were instructed to apply a 10% KOH aqueous solution, twice daily, with a cotton stick to all lesions. Treatment was continued till the lesions showed signs of inflammation or superficial ulceration. Assessments of response and side effects were performed at the end of week 2, week 4, week 8 and week 12. RESULTS We found complete clearance of lesions in 37 (92.5%) patients receiving topical 10%KOH solution after a mean period of four weeks. Three children dropped out of the study; two children reported severe stinging of the lesions and discontinued the treatment; the other patient developed hypopigmentation during the treatment. Local side effects were observed in 12 children (32.4%). CONCLUSION Even though 10% KOH solution is associated with some local side effects, it is a safe, effective, inexpensive and noninvasive alternative treatment of MC in children.
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Affiliation(s)
- Burce Can
- Department of Dermatology, University of Medeniyet Goztepe Training and Research Hospital , Istanbul , Turkey
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22
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Al-Hamdi KI, Al-Rahmani MAA. Evaluation of topical potassium hydroxide solution for treatment of plane warts. Indian J Dermatol 2012; 57:38-41. [PMID: 22470207 PMCID: PMC3312655 DOI: 10.4103/0019-5154.92675] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Plane wart is a common dermatological disease that is caused by human papilloma virus; although the rate of spontaneous recovery is high, it usually takes a long time to occur. Many modalities of treatments have been used but none of them proved to be uniformly effective. Potassium hydroxide (KOH) solution is a well-known keratolytic agent with many dermatological uses. Objective: To evaluate the efficacy and tolerability of topical KOH solution in the treatment of plane warts. Materials and Methods: A total of 250 patients with plane warts, consulting the department of Dermatology and Venereology of Basra Teaching Hospital between March 2008 and October 2009, were enrolled in this opened therapeutic trial study. Patients were divided into two age and sex cross-matched equal groups; patients in group (A) were treated with topical 5% KOH solution once at night, while patients in group (B) were treated with topical 10% KOH solution once nightly. Only 107 patients from group (A) and 95 patients from group (B) completed the study, while the remainders were defaulted for unknown reasons. The patients were evaluated at second and fourth week to assess the cure rates and side effects, those patients who showed complete cure were followed up for 3 months to detect any recurrence. Results: At the end of second week, 9.3% of group (A) patients showed complete disappearance of their warts, vs 66.3% of group (B) patients. At the end of fourth week, 80.3% of group (A) patients showed complete response in comparison with 82.1% of group (B) patients. The side effects for the treating solution in both concentrations include itching, burning sensation, erythema, and temporary dyspigmentations, that were reported in 77.6% of group (A) patients in comparison with 90.5% of group (B) patients. Recurrence rate was reported in 5.8% of group (A) patients vs 5.1% of group (B) patients during the three months period of follow-up. Conclusions: Topical KOH solution is proved to be an effective and safe treatment of plane warts in both concentrations (5% and 10%) with no important side effects.
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Affiliation(s)
- Khalil I Al-Hamdi
- Department of Dermatology and Venereology, College of Medicine, University of Basrah, Iraq.
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Köse O, Özmen İ, Arca E. An open, comparative study of 10% potassium hydroxide solution versus salicylic and lactic acid combination in the treatment of molluscum contagiosum in children. J DERMATOL TREAT 2012; 24:300-4. [DOI: 10.3109/09546634.2011.649690] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Marsal JR, Cruz I, Teixido C, Diez O, Martinez M, Galindo G, Real J, Schoenenberger JA, Pera H. Efficacy and tolerance of the topical application of potassium hydroxide (10% and 15%) in the treatment of molluscum contagiosum: randomized clinical trial: research protocol. BMC Infect Dis 2011; 11:278. [PMID: 22011376 PMCID: PMC3206862 DOI: 10.1186/1471-2334-11-278] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 10/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Molluscum contagiosum is a non-severe pediatric viral infection. Because it is highly contagious and current treatments have negative aesthetic and psychological effects, we want to test an alternative treatment in the primary care setting, consisting of two different concentrations of potassium hydroxide solution. METHODS/DESIGN The study design is a double-blind, randomized clinical trial, using three types of topical treatment. The treatment consist of daily applications of potassium hydroxide (KOH) in aqueous solution at 10% and 15% concentration, and a placebo administered in the control group. Four follow-up visits (at 15, 30, 45 and 60 days) are planned to evaluate treatment effectiveness and patient tolerance. The main outcome measure of the trial will be the healing rate, defined as lesion disappearance in the affected zones after the topic application of the experimental treatment. Secondary measures will be the principal characteristics and evolution of the affected zone (surface area, number of lesions, size and density of lesions), treatment tolerance (hyperpigmentation, itching, burning, pain), recurrence rate and the natural evolution of lesions in the control group. DISCUSSION KOH can potentially be an effective and safe treatment for MC in primary care, and can also reduce referrals to dermatologists and hospital pediatric departments. In addition, KOH may be a valid and less expensive alternative to current invasive treatments (surgical excision).
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Affiliation(s)
- Josep R Marsal
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Rambla de Ferran, 44, 3ª, Lleida, Spain
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Molina L, Romiti R. Molusco contagioso em tatuagem. An Bras Dermatol 2011; 86:352-4. [DOI: 10.1590/s0365-05962011000200022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 05/05/2010] [Indexed: 11/22/2022] Open
Abstract
Molusco contagioso é uma dermatovirose causada por poxvírus e caracterizada por erupção benigna e autolimitada de uma ou múltiplas pápulas esféricas e brilhantes. A transmissão habitualmente ocorre por contato direto com indivíduos infectados. Relata-se caso de doente masculino, 22 anos, com história de surgimento de numerosas pápulas umbilicadas localizadas estritamente sobre a região de uma tatuagem. Exame histopatológico de uma das pápulas confirmou a hipótese clínica de molusco contagioso. Os autores descrevem uma manifestação pouco frequente da disseminação desse vírus em tatuagens e apresentam uma revisão da literatura, enfatizando as vias de transmissão e a terapêutica do molusco contagioso.
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Seo SH, Chin HW, Jeong DW, Sung HW. An open, randomized, comparative clinical and histological study of imiquimod 5% cream versus 10% potassium hydroxide solution in the treatment of molluscum contagiosum. Ann Dermatol 2010; 22:156-62. [PMID: 20548905 DOI: 10.5021/ad.2010.22.2.156] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 12/16/2009] [Accepted: 01/08/2010] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Although molluscum contagiosum (MC) resolves spontaneously, there are several reasons to treat this dermatological disorder. OBJECTIVE To evaluate the safety and efficacy of 5% imiquimod cream versus 10% potassium hydroxide (KOH) solution in treating MC, and to propose the mechanism of cure by observing the histological findings. METHODS Imiquimod or KOH were applied by the patient or a parent 3 days per week until all lesions cleared. The number of MC lesions was counted and side effects were evaluated at 5 points during the treatment (the initial visit, week 2, week 4, week 8, and week 12). Histological changes were compared between 2 patients of each group, before and after the 2 weeks of application. RESULTS In both group, the mean lesion counts decreased all through to week 12, and the reduction in number of lesions were statistically significant in both groups (p <0.005). Over 40% of each group developed local side effects, and no systemic side effects were noted in either group. Before treatment, histological findings showed little or no dermal infiltrates. After treatment, specimens showed dense lymphocytic infiltrates, especially T cells, around the lesions which had resolved. CONCLUSION Both 10% KOH solution and 5% imiquimod cream are effective and safe treatment of MC.
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Affiliation(s)
- Sang-Hee Seo
- Department of Dermatology, Yansan Pusan National University Hospital, School of Medicine, Pusan National University, Yangsan, Korea
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van der Wouden JC, van der Sande R, van Suijlekom-Smit LW, Berger M, Butler CC, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev 2009:CD004767. [PMID: 19821333 DOI: 10.1002/14651858.cd004767.pub3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Molluscum contagiosum is a common skin infection, caused by a pox virus. The infection will usually resolve within months in people with a normal immune system. Many treatments have been used for molluscum contagiosum but a clear evidence base supporting them is lacking.This is an updated version of the original Cochrane Review published in Issue 2, 2006. OBJECTIVES To assess the effects of management strategies (including waiting for natural resolution) for cutaneous, non-genital molluscum contagiosum in otherwise healthy people. SEARCH STRATEGY In June 2009 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 2, 2009), MEDLINE, EMBASE, and LILACS. We also searched ongoing trials registers, reference lists, and contacted pharmaceutical companies and experts in the field. SELECTION CRITERIA We investigated randomised controlled trials (RCTs) for the treatment of molluscum contagiosum. We excluded trials on sexually transmitted molluscum contagiosum and in people with lowered immunity (including those with HIV infection). DATA COLLECTION AND ANALYSIS Two authors independently selected studies, assessed methodological quality, and extracted data from selected studies. MAIN RESULTS Eleven studies, with a total number of 495 participants, examined the effects of topical (9 studies), systemic, and homoeopathic interventions (1 study each). Limited evidence was found for the efficacy of sodium nitrite co-applied with salicylic acid compared to salicylic acid alone (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.23 to 9.92); for Australian lemon myrtle oil compared to its vehicle, olive oil (RR 17.88, 95% CI 1.13 to 282.72); and for benzoyl peroxide cream compared to tretinoin (RR 2.20, 95% CI 1.01 to 4.79). No statistically significant differences were found for 10 other comparisons, most of which addressed 2 topical treatments.Study limitations included no blinding (four studies), many dropouts (three studies), and no intention-to-treat analysis; small study sizes may have led to important differences being missed. None of the evaluated treatment options were associated with serious adverse effects. AUTHORS' CONCLUSIONS No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. The update identified six new studies, most of them reporting on interventions not included in the original version. However, the conclusions of the review did not change.
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Affiliation(s)
- Johannes C van der Wouden
- Department of General Practice, Erasmus MC, University Medical Center, PO Box 1738, Rotterdam, Zuid-Holland, Netherlands, 3000 DR
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Vanhooteghem O, Henrijean A, de la Brassinne M. Épidémiologie, clinique et traitements du molluscum contagiosum : revue de la littérature. Ann Dermatol Venereol 2008; 135:326-32; quiz 325. [DOI: 10.1016/j.annder.2008.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Thiers BH. What's new in dermatologic therapy. Dermatol Ther 2008; 21:142-9. [DOI: 10.1111/j.1529-8019.2008.00181.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Loureiro WR, Cação FM, Belda W, Fagundes LJ, Romiti R. Treatment of genital warts in men with potassium hydroxide. Br J Dermatol 2007; 158:180-1. [PMID: 17970810 DOI: 10.1111/j.1365-2133.2007.08242.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Short KA, Fuller LC, Higgins EM. Double-blind, randomized, placebo-controlled trial of the use of topical 10% potassium hydroxide solution in the treatment of molluscum contagiosum. Pediatr Dermatol 2006; 23:279-81. [PMID: 16780480 DOI: 10.1111/j.1525-1470.2006.00235.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Molluscum contagiosum is a common viral infection of the skin that frequently affects children. Lesions take between 6 and 18 months to resolve spontaneously and are a source of great embarrassment to both caretakers and children, often affecting attendance at school and limiting social activity. Treatment options to date have been poorly tolerated by children but recent studies have suggested that potassium hydroxide may be beneficial. This double-blind, randomized, placebo-controlled study compared 10% potassium hydroxide with placebo (normal saline). Twenty patients, aged 2 to 12 years, were recruited. Parents applied a solution twice daily to lesional skin until signs of inflammation appeared. Children were examined by the same observer on days 0, 15, 30, 60, and 90. Seventy percent of children receiving topical potassium hydroxide cleared, compared with 20% in the placebo group. Further dosing studies are required to identify whether weaker concentrations of potassium hydroxide are as efficacious, with less irritancy.
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Affiliation(s)
- Katherine A Short
- Department of Dermatology, King's College Hospital, Denmark Hill, London, United Kingdom.
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van der Wouden JC, Menke J, Gajadin S, Koning S, Tasche MJA, van Suijlekom-Smit LWA, Berger MY, Butler CC. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev 2006:CD004767. [PMID: 16625612 DOI: 10.1002/14651858.cd004767.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Molluscum contagiosum is a common skin infection, caused by a virus, which will usually resolve within months in people with a normal immune system. Many treatments have been promoted for molluscum contagiosum but a clear evidence base supporting them is lacking. OBJECTIVES To assess the effects of management strategies (including waiting for natural resolution) for cutaneous, non-genital molluscum contagiosum in healthy people. SEARCH STRATEGY We searched the Skin Group Specialised Register (March 2004), the Cochrane Central Register of Controlled Trials (2004, Issue 2), MEDLINE (from 1966 to March 2004), EMBASE (from 1980 to March 2004) and LILACS (from 1982 to March 2004) databases. We also searched reference lists and contacted pharmaceutical companies and experts in the field. SELECTION CRITERIA Randomised controlled trials for treatment of molluscum contagiosum were investigated. Trials on sexually transmitted molluscum contagiosum and in people with lowered immunity (including those with HIV infection) were excluded. DATA COLLECTION AND ANALYSIS Study selection and assessment of methodological quality were carried out by two independent authors. As similar comparisons between two interventions were not made in more than one study, statistical pooling was not performed. MAIN RESULTS Five studies, with a total number of 137 participants, examined the effects of topical (three studies), systemic and homoeopathic interventions (one study each). Limited evidence was found for sodium nitrite co-applied with salicylic acid compared to salicylic acid alone (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.23 to 9.92). No statistically significant differences were found for topical povidone iodine plus salicylic acid compared to povidone iodine alone (RR of cure 1.67, 95% CI 0.81 to 3.41) or compared to salicylic acid alone. Also no statistically significant differences were found for potassium hydroxide compared to placebo; systemic treatment with cimetidine versus placebo or systemic treatment with calcarea carbonica, a homoeopathic drug, versus placebo (RR 5.57, 95% CI 0.93 to 33.54). Study limitations included no blinding (two studies), many dropouts (three studies) and no intention-to-treat analysis (two studies); small study sizes may have led to important differences being missed. None of the evaluated treatment options were associated with serious adverse effects. AUTHORS' CONCLUSIONS No single intervention has been shown to be convincingly effective in treating molluscum contagiosum.
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Affiliation(s)
- J C van der Wouden
- University Medical Center Rotterdam, Department of General Practice, Erasmus MC, Room Ff304, PO Box 1738, Rotterdam, Netherlands, 3000 DR.
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Affiliation(s)
- Justin Brown
- Dermatology Department, New Jersey Medical School, Newark, New Jersey 07103-2714, USA
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Woodward J. Lymphogranuloma Venereum, Chancroid, Granuloma Inguinale, and Molluscum Contagiosum. Sex Transm Dis 2006. [DOI: 10.1007/978-1-59745-040-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kakourou T, Zachariades A, Anastasiou T, Architectonidou E, Georgala S, Theodoridou M. Molluscum contagiosum in Greek children: a case series. Int J Dermatol 2005; 44:221-3. [PMID: 15807730 DOI: 10.1111/j.1365-4632.2004.02074.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Epidemiological studies of molluscum contagiosum (MC) in children are limited. PATIENTS AND METHOD Between 1997 and 1999, 110 children with MC (60 boys, 50 girls, mean age: 4.8 years) were studied. Treatment consisted of removal of all MC lesions in a single session by sterilized tweezers. RESULTS In children aged < or = 2 years, the MC lesions were located mainly on the face, whereas in older children they were located on the trunk. Twenty children had atopic dermatitis (18.2% vs. 5% of Greek children aged 1-6 years; P < 0.001). Four children had numerous and recurrent MC lesions without any other systemic manifestations. In these children, humoral and cellular immunities were found to be normal. Seventy-seven children (70%) were cured after one treatment session, 22 children (20%) after a second session and 11 (10%) after > or = three sessions. No patients experienced secondary bacterial infection or scarring. CONCLUSIONS In contrast to cool climates where the age of peak incidence of MC in children is 10-12 years, in a warm country such as Greece, it is at the younger age of 4.8 years. In young children aged 2 years, the MC lesions are located mainly on the face, whereas in older children they are located on the trunk. Atopic dermatitis is a predisposing factor for MC. In cases where MC lesions are numerous and/or persist but there are no other signs of systemic infections, the possibility of immunodeficiency is minimal. Removal of MC lesions by tweezers is an efficient, simple and inexpensive method of treatment without sequelae.
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Affiliation(s)
- Talia Kakourou
- First Department of Pediatrics, Athens University, Aghia Sophia Children's Hospital, 11527 Athens, Greece.
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Abstract
Pediatric molluscum contagiosum virus (MCV) is a common pox viridae infection that represents a common public health issue. The spread of the virus among children is rapid and easy. The virus produces a number of substances that block immune response formation in the infected host. Despite the benign and self-limited nature of the condition, one-third of children have symptoms from, or secondary reactions to the infection, including pruritus, erythema and, occasionally, inflammation and pain. Patients with pruritus autoinoculate the virus through scratching, thereby exacerbating their conditions. While adults cope well with unanesthetized curettage of lesions, children require less painful therapeutic options. The options for therapy are manifold. Therapy should begin with gentle skin care and antipruritics to prevent symptoms, and to prevent the spread of the disease. Therapies with good efficacy and low risk of pain for the patient include in-office usage of cantharidin and the use of local anesthetics, such as topical lidocaine (lignocaine) preparations in combination with the curettage of visible lesions. Alternatively, cryosurgery can be performed to eradicate lesions in-office. At-home therapeutics are often preferred by parents and children, and include imiquimod, retinoids, and alpha-hydroxy acids. Although a variety of such at-home therapies are available, none are as effective or as rapid acting as in-office therapy. Further research in large clinical trials is required to increase knowledge on prevention, optimal treatment, and long-term outcome with this disease.
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Affiliation(s)
- Nanette Silverberg
- Pediatric Dermatology, St. Luke's-Roosevelt Hospital Center, and Columbia College of Physicians and Surgeons, New York, New York 10025, USA.
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&NA;. Treatment of molluscum contagiosum is more difficult in immune compromised patients. DRUGS & THERAPY PERSPECTIVES 2003. [DOI: 10.2165/00042310-200319070-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Smith KJ, Skelton H. Molluscum contagiosum: recent advances in pathogenic mechanisms, and new therapies. Am J Clin Dermatol 2002; 3:535-45. [PMID: 12358555 DOI: 10.2165/00128071-200203080-00004] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Two poxviruses, Molluscum contagiosum virus (MCV) and Variola virus are specific to humans. MCV is present worldwide and is directly passed by direct skin to skin contact to produce cutaneous and, rarely, mucosal lesions. It occurs predominantly in preadolescent children, sexually active adults, participants in sports with skin to skin contact, and in individuals with impaired cellular immunity. MCV characteristically proliferates within the follicular epithelium, and with routine fixation produces an area of retraction artifact separating layers 1 to 3 of CD34+ stromal cells that immediately surround the follicle from the surrounding dermis. This feature may be obscured when the lesions are inflamed, usually after rupture into the surrounding dermis. MCV is a cytoplasmically replicating virus. MCV-infected cells grow in size, while internal organelles are dislocated and eventually obliterated by a large intracytoplasmic inclusion. Rupture and discharge of the virus-packed cells occurs in a process similar to membrane debris and MCV accumulate in the crater-like ostium; MCV infection is spread by contact with infectious debris. In HIV-1-positive patients the histologic features, as well as the clinical features, may be atypical in patients with MCV infections. Not only are the lesions often large, but they may be verrucous and markedly hyperkeratotic. Recent sequencing of the MCV genome has increased our understanding and investigations into its mechanisms for avoiding host defense mechanisms. These include regions which encode for homologues of cellular chemokines and chemokine-binding proteins, a homolog of MHC1 and a viral FLICE-like inhibitory protein. Treatment, until recently, has depended upon tissue destruction including curettage, cryotherapy, CO(2) laser, electrodesiccation, trichloracetic acid and cantharadin. Recently, topical immune modulators have been used with some success. Understanding of the MCV genome is providing the basis for the development of drugs for therapy and prevention of MCV infections.
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Affiliation(s)
- Kathleen J Smith
- Department of Dermatology and Pathology, University of Alabama, Birmingham, AL 35294, USA.
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Abstract
Molluscum contagiosum is a benign cutaneous viral disease. This article describes 5 immunocompetent patients with molluscum contagiosum who were successfully treated with imiquimod 5% cream.
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Affiliation(s)
- Robert B Skinner
- Department of Medicine (Dermatology), University of Tennessee, Memphis, 38163, USA
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Romiti R, Ribeiro AP, Romiti N. Evaluation of the effectiveness of 5% potassium hydroxide for the treatment of molluscum contagiosum. Pediatr Dermatol 2000; 17:495. [PMID: 11189099 DOI: 10.1046/j.1525-1470.2000.01837-7.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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