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Hebert AA, Bhatia N, Del Rosso JQ. Molluscum Contagiosum: Epidemiology, Considerations, Treatment Options, and Therapeutic Gaps. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:S4-S11. [PMID: 37636018 PMCID: PMC10453394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Molluscum contagiosum (MC) is a viral infection that affects primarily pediatric patients, sexually active young adults, and immunocompromised people of all ages. MC occurs all over the world, making up about one percent of skin disorders and appears to be increasing in prevalence. This cutaneous infection is often associated with atopic dermatitis and is typically self-limiting, although spontaneous resolution can take months to years. Many treatments exist, but only one-a drug-device product using topical cantharidin- is approved by the United States (US) Food and Drug Administration (FDA) for treatment of MC. For many years, there was a lack of an established or FDA-approved first-line treatment for MC, which might have contributed to the common "benign neglect" attitude of physicians regarding treatment of MC. Unfortunately, this noninterventional approach can increase risk of spreading infection and result in longer duration of infection, physical discomfort, and psychosocial issues due to persistence of the MC lesions. This article reviews available epidemiology data and explores treatment options and therapeutic gaps in MC management.
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Affiliation(s)
- Adelaide A Hebert
- Dr. Hebert is with UTHealth McGovern Medical School in Houston, Texas
| | - Neal Bhatia
- Dr. Bhatia is with Therapeutics Clinical Research in San Diego, California
| | - James Q Del Rosso
- Dr. Del Rosso is with JDR Dermatology Research and Thomas Dermatology in Las Vegas, Nevada, and Clinical Research at Advanced Dermatology and Cosmetic Surgery in Maitland, Florida
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2
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Choudhary D, Yadav C, Kachhawa D, Rajoriya D. Clinical study to evaluate the efficacy of autoinoculation in genital molluscum contagiosum in reproductive age group. Indian J Sex Transm Dis AIDS 2023; 44:135-138. [PMID: 38223148 PMCID: PMC10785101 DOI: 10.4103/ijstd.ijstd_102_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/11/2023] [Accepted: 06/01/2023] [Indexed: 01/16/2024] Open
Abstract
Context Molluscum contagiosum (MC) typically presents as asymptomatic or itchy, discrete, smooth, flesh-colored, dome-shaped papules with central umbilication. Lesions on the genitals are often sexually transmitted and tend to be seen in young adults. Homologous auto implantation is a simple technique which helps in inducing a cell-mediated immune response to the antigens, aiding clearance of both local and distant lesions. Aim and Objectives The aim of the study is to evaluate the efficacy and side effect of the technique of autoinoculation for the treatment of genital MC in terms of reduction in number of lesions. Materials and Methods Thirty-one patients having >5 genital molluscum attending skin outpatient department were enrolled out of which 30 remain. A well-defined mc lesion was approached using an insulin syringe (30 G) and pierced from a site just adjacent to the lesion. Results were assessed every 2 weeks for 2 months. Results 60% (n = 18) patients showed excellent response, 20% (n = 6) patients showed very good response, 6.6% (n = 2) patients showed good response and 13.3% (n = 4) showed poor response at the end of the study. Conclusion The autoinoculation technique is an effective technique in terms of excellent clearance of MC lesions with fewer chances of recurrence, side effects, and shorter duration taken to achieve a complete response to distant lesions.
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Affiliation(s)
- Durga Choudhary
- Department of Dermatology, Venerology, and Leprosy, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - Chinmai Yadav
- Department of Dermatology, Venerology, and Leprosy, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - Dilip Kachhawa
- Department of Dermatology, Venerology, and Leprosy, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - Deepti Rajoriya
- Department of Dermatology, Venerology, and Leprosy, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
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Samagani A, Raveendra L, Raju BP. A Therapeutic Trial Comparing Modified Autoinoculation, a Novel Approach with Topical Potassium Hydroxide Application in the Treatment of Molluscum Contagiosum. J Cutan Aesthet Surg 2022; 15:65-70. [PMID: 35655641 PMCID: PMC9153309 DOI: 10.4103/jcas.jcas_228_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Molluscum contagiosum (MC) is a common viral cutaneous infection. Despite multiple treatment options, there is no definitive treatment. In some cases, the lesions are severe, recurrent, and cosmetically odd. Modified autoinoculation (MAI) is a novel technique that induces cell-mediated immunity resulting in clearance of local as well as distant lesions. Potassium hydroxide (KOH) acts by dissolving the keratin and penetrating deeply destroys the hyperproliferative tissue. We would here like to compare MAI with topical KOH in the treatment of MC. Aims and Objective The aim of this study was to assess the effectiveness of MAI in treatment of MC and to compare its response with topical KOH application. Settings and Design This was an open-labeled longitudinal therapeutic outcome study carried out at a tertiary care center over a period of 1 year. Materials and Methods Hundred consenting MC patients attending the department of dermatology were randomized into Group A and Group B. Group A patients were subjected to MAI and Group B to topical application of 10% KOH. Statistical Analysis Used The continuous variables are presented as mean ± standard deviation (SD). The difference between the mean score was analyzed using Student's t test for independent variable and paired t test for paired results. Results At the end of 16 weeks, 91.48% showed complete clearance by MAI compared to 81.64% with topical 10% KOH solution. There was a significant reduction of mean score of lesions in patients treated by MAI compared to patients treated with KOH. Conclusion MAI therapy provides a promising, easy, cost-effective, daycare option for MC infections.
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Affiliation(s)
- Akshay Samagani
- Department of Dermatology, Venereology & Leprosy, RajaRajeswari Medical College & Hospital, Bengaluru, Karnataka, India
| | - Leena Raveendra
- Department of Dermatology, Venereology & Leprosy, RajaRajeswari Medical College & Hospital, Bengaluru, Karnataka, India
| | - Belliappa P. Raju
- Department of Dermatology, Venereology & Leprosy, RajaRajeswari Medical College & Hospital, Bengaluru, Karnataka, India
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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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5
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Gualdi G, Pascalucci C, Panarese F, Prignano F, Giuliani F, Verga E, Amerio P, Verdolini R. Molluscum contagiosum in pediatric patients: to treat or not to treat? Could a personalized imiquimod regimen be the answer to the dilemma? J DERMATOL TREAT 2020; 33:443-448. [PMID: 32347136 DOI: 10.1080/09546634.2020.1762840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Although molluscum contagiosum virus (MCV) infection is a common disease widespread among children and young adults, there is no shared opinion on treatment that can be divided into physical, chemical, medical (immunomodulating or anti-viral). According to some authors, MCV is best left to clear by itself.Objectives: To assess the clearance of MCV lesions in a sample of pediatric patients. It compares outcomes in treated with Imiquimod cream, compared with non-treated patients.Methods: The sample consits of 48 pediatric patients affected by MVC clinically diagnosed. It was divided into two groups: Group I, treated with Imiquimod 5% cream once/day until the onset of a visible inflammatory reaction. Once the reaction was illicited, application was suspended until the irritation resolved. If the lesion was still present, drug was administered again using the same regimen. The cycle was repeated until complete clinical resolution. Group II, control, comprises non-treated patients. Follow up visits were carried out 12, 16, 20, 48, and 52 weeks from the beginning of treatment.Results: At week 20, all patients except one in the treated group were lesion free. Persistence of MCV lesions was documented in one patient only until week 48. In the control group all patients were still affected by MCV lesions during the follow-up period. Spontaneous clinical resolution of the infection was observed in only 2 patients at week 52. The results of the study show Imiquimod's significant efficacy.Conclusions: Our study is one of the few case-control studies in pediatric population carried out with such long-term follow-up. Efficacy of this personalized treatment, scarce recurrence, absence of cicatricial sequelae and lack of necessity for deep sedation, in the case of children with disseminated lesions, makes the use of Imiquimod the first line of treatment compared with other destructive treatments or with no-treatment at all.
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Affiliation(s)
- Giulio Gualdi
- Dermatologic Clinic, Department of Medicine and Ageing Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Chiara Pascalucci
- Dermatologic Clinic, Department of Medicine and Ageing Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Fabrizio Panarese
- Dermatologic Clinic, Department of Medicine and Ageing Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Francesca Prignano
- Dermatology Clinic/ASF Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Federica Giuliani
- Dermatologic Clinic, Department of Medicine and Ageing Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Emanuele Verga
- Department of Dermatology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Paolo Amerio
- Dermatologic Clinic, Department of Medicine and Ageing Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Roberto Verdolini
- Department of Dermatology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
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El tratamiento de las verrugas con guarumbo por los zapotecos. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:189-191. [DOI: 10.1016/j.ad.2018.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 11/17/2022] Open
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Fernandez-Flores A, Llamas Velasco M, Saeb Lima M. Guarumbo (Cecropia obtusifolia) for Warts in Zapotec Medicine. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2018.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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8
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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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Huu SN, Quang MN, Van TN, Cao KP, Thu HDT, Thi LP, Cam VT, Huyen ML, Hau KT, Gandolfi M, Satolli F, Feliciani C, Tirant M, Vojvodic A, Lotti T. Efficacy of 10% Potassium Hydroxide Solution Versus 10% Salicylic Acid Ointment in Treatment of Molluscum Contagiosum - the Low - Cost Dermatologic Therapy in Vietnam. Open Access Maced J Med Sci 2019; 7:269-271. [PMID: 30745977 PMCID: PMC6364743 DOI: 10.3889/oamjms.2019.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: Molluscum contagiosum is a common viral disease primarily affecting children. AIM: The objective is to compare the efficacy of 10% potassium hydroxide (KOH) solution versus 10% salicylic pomade in the treatment of molluscum contagiosum. METHODS: Clinical trials on 70 patients were randomised into 2 groups: 39 patients treated with 10% KOH solution and 31 patients treated with 10% salicylic pomade. The evaluation was based on the complete clearance of lesions, side effects and complications of the drug. RESULTS: The clearance of all lesions after 2, 4, 6, 8 weeks of treatment in both groups were 7.7%; 23.1%; 53.8%; 79.5% and 0%; 3.2%, 9.7% 22.6%, respectively (p < 0.05). Side effects were seen in both groups include burning (76.9% versus 19.4%; p < 0.05); redness (59% versus 14%; p < 0.01); desquamation (12.8% versus 19.3%; p < 0.05). CONCLUSION: The efficacy of KOH solution in the treatment of MC was better than that of salicylic pomade and both products are safe, effective, and easy to apply at home.
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Affiliation(s)
- Sau Nguyen Huu
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | | | - Thuong Nguyen Van
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Kiem Pham Cao
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Hien Do Thi Thu
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Lan Pham Thi
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Van Tran Cam
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - My Le Huyen
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Khang Tran Hau
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | | | | | | | - Michael Tirant
- University of Rome G. Marconi, Rome, Italy.,Psoriasis Eczema Clinic, Melbourne, Australia
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy of Belgrade, Belgrade, Serbia
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10
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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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11
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Kachhawa D, Sonare D, Vats G. Autoinoculation as a treatment modality for molluscum contagiosum: A preliminary uncontrolled trial. Indian J Dermatol Venereol Leprol 2018; 84:76-78. [PMID: 29251278 DOI: 10.4103/ijdvl.ijdvl_1033_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Dilip Kachhawa
- Department of DVL, Dr SN Medical College, Jodhpur, Rajasthan, India
| | - Durgesh Sonare
- Department of DVL, Dr SN Medical College, Jodhpur, Rajasthan, India
| | - Gauri Vats
- Department of DVL, Dr SN Medical College, Jodhpur, Rajasthan, India
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12
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Abstract
Molluscum contagiosum (MC) is an infectious dermatosis that commonly presents in children and immunocompromised individuals. Although lesions usually resolve spontaneously after several months, they can be symptomatic and cause psychosocial distress. We review the evidence underlying treatment methods available for MC lesions, including potassium hydroxide, salicylic acid, hydrogen peroxide, retinoids, cantharidin, cryotherapy, curettage, and pulsed dye laser to aid practicing dermatologists in therapy selection.
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Affiliation(s)
| | - Firas Al-Niaimi
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Faisal R Ali
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
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13
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Evaluation of efficacy of an intralesional injection of Candida antigen in the treatment of molluscum contagiosum. JOURNAL OF THE EGYPTIAN WOMEN’S DERMATOLOGIC SOCIETY 2017. [DOI: 10.1097/01.ewx.0000516171.71159.fc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Hanna E, Abadi R, Abbas O. Imiquimod in dermatology: an overview. Int J Dermatol 2017; 55:831-44. [PMID: 27387373 DOI: 10.1111/ijd.13235] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/28/2015] [Accepted: 11/04/2015] [Indexed: 11/28/2022]
Abstract
Imiquimod is an immune response modifier commercially available as a 3.75 and 5% cream. Topical imiquimod stimulates the innate and adaptive immune responses and induces cytokine production. This allows its use for the treatment of a wide variety of benign and malignant skin conditions due to its potential antiviral, antitumor, and immunoregulatory effects. Currently, topical imiquimod is US Food and Drug Administration (FDA)-approved for the treatment of anogenital warts, actinic keratosis, and superficial basal cell carcinomas. However, it has also shown a beneficial effect in the treatment of many other skin disorders. In this review, we describe existing evidence on the mechanism of action of topical imiquimod, its FDA-approved indications, off-label uses, and side effects.
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Affiliation(s)
- Edith Hanna
- American University of Beirut-Medical Center, Beirut, Lebanon
| | - Rami Abadi
- American University of Beirut-Medical Center, Beirut, Lebanon
| | - Ossama Abbas
- American University of Beirut-Medical Center, Beirut, Lebanon
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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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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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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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Abstract
Molluscum contagiosum is a common reason for consultation in primary care. The condition is normally benign and self-limiting1 and the standard advice is to wait for the lesions to resolve spontaneously.2 Recently, potassium hydroxide 5% (MolluDab-Alliance Pharmaceuticals Limited) has been marketed in the UK for the treatment of the condition.3 It is sold as a medical device rather than a licensed medicinal product. Here we consider the evidence for potassium hydroxide 5% in the management of molluscum contagiosum.
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Abstract
SUMMARY Three cases of molluscum contagiosum (MC) approached our outpatient Department of Dermatology complaining of umbilicated, skin-colored, firm, painless papules over the neck and face. All of them were immune competent. The medical, social, and family history was insignificant. The lesions were, numerous and recurrent. However, MC in healthy people is a self-limiting disease, but it will take about 18 months to resolve by its own. Hence, the treatment becomes necessary to accelerate the healing process, preventing its spread and for cosmetic reasons. Most of the contemporary treatment methods such as cryotherapy, curettage, and topical application of caustic agents are effective but produce local side-effects such as erythema, tenderness, itching, burning sensation, and pain. The present study reports the efficacy of external application of Pratisaraṇīya Kṇāra (the type of Alkali used for smearing over the affected area) and Bilvādi Agada tablet orally in three cases, which yielded encouraging results.
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Affiliation(s)
| | - Mahesh P Sawalgimath
- Department of Agada Tantra, KLEU Shri BMK Ayurved Mahavidhyalaya, Belgaum, Karnataka, India
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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: 128] [Impact Index Per Article: 11.6] [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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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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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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