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Topical 0.3% and 0.5% Podophyllotoxin Cream for Self-Treatment of Molluscum contagiosum in Males
Abstract
Background: Molluscum contagiosum is generally a self-limiting benign skin disease that affects mostly children and young adults. Objective: The purpose of this multicenter, double-blind, placebo-controlled study was to compare the clinical efficacy and tolerance of 0.3% and 0.5% podophyllotoxin in a hydrophilic cream base to cure molluscum contagiosum in Asian males. Methods: Preselected patients (n = 150), age range 10–26 years (mean: 15.4), harboring 1,125 lesions (mean: 7.5), with size ranging from 2 to 8 mm in diameter (mean spot size 3.2 mm) and biopsy-proven diagnosis of molluscum contagiosum, were randomly allocated to three parallel groups. Twenty-four (16%) patients had atopic dermatitis. Patients self-administered placebo, 0.3% or 0.5% podophyllotoxin cream, twice daily for 3 consecutive days, and if total elimination was not achieved with one trial (6 topical applications), the same treatment was extended to 3 more weeks (24 topical applications in 4 weeks). The duration of the study was 12 weeks with 6 months (on monthly basis) follow-up. By the end of the treatment 80 patients (52, 92 and 16% patients in the 0.3%, 0.5% and the placebo groups, respectively) were evaluated as completely cured. During the treatment 92 patients (61.3%) did not complain of any allergic or localized adverse symptoms. Tolerable moderate to mild frequent side effects were pruritus (20.6%) and erythema (18%), with no dropouts. No recurrence was seen after 9 months of follow-up. Response to the trial medications appeared to be directly proportional to the concentration of podophyllotoxin (p < 0.001). Self-medication was well accepted by all the patients. It was concluded that the 0.5% podophyllotoxin cream preparation was more efficacious than the 0.3% incorporation (p < 0.001) and can be considered a safe, home-based first line of therapy to cure molluscum contagiosum.
... [98][99][100] Topical treatments include 0.7% cantharidin application and 0.5% podophyllotoxin cream application twice daily for 3 days, which was reported to be more efficacious than the 0.3% strength. 101,102 Other topical options include 5% Imiquimod cream, iodine and salicylic acid, potassium hydroxide and tretinoin. 103 ...
Poxviridae have been successful pathogens throughout recorded history, infecting humans among a variety of other hosts. Although eradication of the notorious smallpox has been a globally successful healthcare phenomenon, the recent emergence of Monkeypox virus, also belonging to the Orthopoxvirus genus and causing human disease, albeit milder than smallpox, is a cause of significant public health concern. The ongoing outbreak of monkeypox, demonstrating human–human transmission, in previously nonendemic countries, calls for critical need into further research in the areas of viral biology, ecology, and epidemiology to better understand, prevent and treat human infections. In the wake of these recent events, it becomes important to revisit poxviral infections, their pathogenesis and ability to cause infection across multiple nonhuman hosts and leap to a human host. The poxviruses that cause human diseases include Monkeypox virus, Molluscum contagiosum virus, and Orf virus. In this review, we summarize the current understanding of various poxviruses causing human diseases, provide insights into their replication and pathogenicity, disease progression and symptoms, preventive and treatment options, and their importance in shaping modern medicine through application in gene therapy, oncolytic viral therapies for human cancers, or as poxvirus vectors for vaccines.
... Topical treatments include 0.7% cantharidin application and 0.5% podophyllotoxin cream application twice daily for 3 days, which was reported to be more efficacious than the 0.3% strength (101,102). Other topical options include 5% Imiquimod cream, iodine and salicylic acid, potassium hydroxide and tretinoin (103). ...
Poxviridae have been successful pathogens throughout recorded history, infecting humans among a variety of other hosts. Although eradication of the notorious smallpox has been a globally successful healthcare phenomenon, the recent emergence of Monkeypox virus, also belonging to the Orthopoxvirus genus and causing human disease, albeit milder than smallpox, is a cause of significant public health concern. The ongoing outbreak of monkeypox, demonstrating human-human transmission, in previously non-endemic countries, calls for critical need into further research in the areas of viral biology, ecology and epidemiology to better understand, prevent and treat human infections. In the wake of these recent events, it becomes important to revisit poxviral infections, their pathogenesis and ability to cause infection across multiple non-human hosts and leap to a human host. The poxviruses that cause human diseases include Monkeypox virus, Molluscum conta-giosum virus and Orf virus. In this review we summarize the current understanding of various pox-viruses causing human diseases, provide insights into their replication and pathogenicity, disease progression and symptoms, preventive and treatment options and their importance in shaping modern medicine through application in gene therapy, oncolytic viral therapies for human cancers or as poxvirus vectors for vaccines.
... For treatment of external genital warts caused by nononcogenic HPVs, recommended treatments includes Podophyllotoxin (an antimitotic agent destroying warts) [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44], Imiquimod (an imidazoquinolinamine derivative inducing macrophages to secret IL-2 and IFN-α cytokines which were approved for HPV genital warts by the US Food and Drug Administration (FDA)) [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59], and Sinecatechins (a compound derived from green tea leaves of the Camellia sinensis species containing active ingredient epigallocatechingallate with various immunomodulatory and antiproliferative properties activating the caspase pathway and inhibiting telomerase) [60][61][62][63][64][65] and Trichloroacetic acid 80-90%. [66][67][68]. ...
Human papillomavirus (HPV) is the most common sexually transmitted virus in the world. About 70% of cervical cancers are caused by the most oncogenic HPV genotypes of 16 and 18. Since available prophylactic vaccines do not induce immunity in those with established HPV infections, the development of therapeutic HPV vaccines using E6 and E7 oncogenes, or both as the target antigens remains essential. Also, knocking out the E6 and E7 oncogenes in host genome by genome-editing CRISPR/Cas system can result in tumor growth suppression. These methods have shown promising results in both preclinical and clinical trials and can be used for controlling the progression of HPV-related cervical diseases. This comprehensive review will detail the current treatment of HPV-related cervical precancerous and cancerous diseases. We also reviewed the future direction of treatment including different kinds of therapeutic methods and vaccines, genome-editing CRISPR/Cas system being studied in clinical trials. Although the progress in the development of therapeutic HPV vaccine has been slow, encouraging results from recent trials showed vaccine-induced regression in high-grade CIN lesions. CRISPR/Cas genome-editing system is also a promising strategy for HPV cancer therapy. However, its safety and specificity need to be optimized before it is used in clinical setting.
... Type of medication Cream 180 days 150 molluscum contagiosum (Syed et al., 1994) ...
Objective:
The aim of the present review is to give an overview about the role, biosynthesis, and characteristics of Podophyllotoxin (PTOX) as a potential antitumor agent with particular emphasis on key biosynthesis processes, function of related enzymes and characterization of genes encoding the enzymes.
Materials and methods:
Google scholar, PubMed and Scopus were searched for literatures which have studied identification, characterization, fermentation and therapeutic effects of PTOX and published in English language until end of 2016.
Results:
PTOX is an important plant-derived natural product, has derivatives such as etoposide and teniposide, which have been used as therapies for cancers and venereal wart. PTOX structure is closely related to the aryltetralin lactone lignans that have antineoplastic and antiviral activities. Podophyllum emodi Wall. (syn. P. hexandrum) and Podophyllum peltatum L. (Berberidaceae) are the major sources of PTOX. It has been shown that ferulic acid and methylenedioxy substituted cinnamic acid are the enzymes involved in PTOX synthesis. PTOX prevents cell growth via polymerization of tubulin, leading to cell cycle arrest and suppression of the formation of the mitotic-spindles microtubules.
Conclusion:
Several investigations have been performed in biosynthesis of PTOX such as cultivation of these plants, though they were unsuccessful. Thus, it is important to find alternative sources to satisfy the pharmaceutical demand for PTOX. Moreover, further preclinical studies are warranted to explore the molecular mechanisms of these agents in treatment of cancer and their possible potential to overcome chemoresistance of tumor cells.
The vulva can be involved as apart of more generalised dermatological disease but there are specific disorders that affect the genital skin. This chapter discusses the dermatoses, infections, premalignant and malignant disease and pain that affect the female genital skin.
Viruses can cause disease in the skin or mucosa by direct infection or, via a systemic infection, produce secondary skin abnormalities. The chapter reviews the viruses associated with skin lesions, outlining the pathophysiology, the clinical features, diagnostic methods and the approaches to treatment. Primary skin infection following direct contact occurs with poxviruses, some herpesviruses and papillomaviruses leading to visible features which may be readily diagnostic. Less specific skin changes are seen with systemic infections, when infection is often via mucosae or inoculation, for example with parvovirus, measles or coronavirus and for these infections, diagnosis will usually involve body fluid analysis.
Molluscum contagiosum (MC) is a common viral infection that affects the skin of children. This study compared demographic data and treatment patterns for MC patients across US medical specialties. Using the National Ambulatory Medical Care Survey database from 2000 to 2016, we found an average of 471,383 pediatric MC visits yearly. Most visits were made by Caucasians (91.0%) or non-Hispanics (82.9%). Pediatricians handled most cases (46.5%), followed by dermatologists (36.8%) and family medicine physicians (10.6%). Dermatologists saw more Caucasian patients (95% vs. 84%) and more patients with private insurance (83% vs. 73%) than pediatricians. Patients living in non-metropolitan areas were more likely to visit family medicine physicians (55.0%) than pediatricians (26.4%) or dermatologists (16.3%). Pediatricians favored spontaneous resolution (70%) over dermatologists (38%). Pediatricians mainly used terpenoids (12%), steroids (4%), and imiquimod (4%), while dermatologists preferred terpenoids (20%), imiquimod (12%), and curettage (10%). Pediatricians oversee most MC cases, but treatment strategies significantly differ from the best-practice guidelines.
Molluscum contagiosum (MC) is a benign, self-limited viral disease of the skin and rarely mucous membranes caused by molluscum contagiosum virus (MCV), a double-stranded DNA poxvirus. The disease mainly affects children, sexually active adults, and immunocompromised individuals. The typical lesion is a shiny, pearly white, hemispherical papule with central umbilication and an average diameter of 3–5 mm.
In immunocompetent patients MC is a benign disorder that resolves spontaneously within 6–18 months, although it may persist for as long as 5 years. Disseminated lesions, as seen in immunocompromised patients, are persistent and recurrent, and they may be a marker of advanced disease. Diagnosis of MC is usually made relatively easy on the basis of clinical presentation. Rapid freezing with ethyl chloride or liquid nitrogen may accentuate their distinctive umbilication. Therapy of MC should be undertaken in an individualized manner; a specific treatment does not exist. The treatment method should be chosen after consideration of the age and immunocompetence of the patient, the extent of the disease, and the areas involved. Treatment has focused on removing the cutaneous lesions either by surgery or by producing epidermal injury and subsequent desquamation of the molluscum and surrounding uninvolved skin.
Zusammenfassung
Hintergrund und Ziele
Obwohl verschiedene Interventionen zur Behandlung von Molluscum contagiosum eingesetzt wurden, sind Nutzen und Wirksamkeit nach wie vor unklar. Um die Wirksamkeit und Sicherheit der Interventionen gegen Molluscum contagiosum vergleichend zu beurteilen, wurde eine Netzwerk‐Metaanalyse durchgeführt.
Patienten und Methodik
Embase, PubMed und Cochrane Library wurden nach Artikeln durchsucht, die zwischen dem 1. Januar 1990 und dem 30. November 2020 veröffentlicht wurden. Geeignet waren randomisierte klinische Studien (randomized clinical trials, RCT) von Interventionen bei immunkompetenten Kindern und Erwachsenen mit genitalen/nichtgenitalen Molluscum contagiosum‐Läsionen.
Ergebnisse
Zwölf Interventionen aus 25 RCT mit 2123 Teilnehmern wurden beurteilt. Im Vergleich mit Placebo hatte Ingenolmebutat den deutlichsten Effekt auf die vollständige Abheilung (Odds Ratio [OR] 117,42, 95%‐Konfidenzintervall [KI] 6,37–2164,88), gefolgt von Kryotherapie (OR 16,81, 95%‐KI 4,13–68,54), Podophyllotoxin (OR 10,24, 95%‐KI 3,36–31,21) und Kaliumhydroxid (KOH) (OR 10,02, 95%‐KI 4,64–21,64). Aufgrund der dürftigen Datenlage konnte keine quantitative Synthese zu unerwünschten Wirkungen durchgeführt werden.
Schlussfolgerungen
Ingenolmebutat, Kryotherapie, Podophyllotoxin und KOH waren hinsichtlich einer vollständigen Abheilung wirksamer als die anderen Interventionen. Allerdings wurden vor kurzem Sicherheitsbedenken hinsichtlich Ingenolmebutat geäußert. Aufgrund der Möglichkeit einer spontanen Abheilung ist bei asymptomatischen Infektionen auch nur deren Beobachtung gerechtfertigt. Faktoren wie unerwünschte Wirkungen, Kosten, Patientenwunsch und medizinische Verfügbarkeit sollten berücksichtigt werden.
Background and objectives:
Various interventions have been applied to treat molluscum contagiosum, but benefits and efficacy remain unclear. To assess the comparative efficacy and safety of interventions for molluscum contagiosum, a network meta-analysis was performed.
Patients and methods:
Embase, PubMed, and the Cochrane Library were searched for articles published between January 1, 1990, and November 31, 2020. Eligible studies were randomized clinical trials (RCTs) of interventions in immunocompetent children and adults with genital/non-genital molluscum contagiosum lesions.
Results:
Twelve interventions from 25 RCTs including 2,123 participants were assessed. Compared with the placebo, ingenol mebutate had the most significant effect on complete clearance (odds ratio [OR] 117.42, 95% confidence interval [CI] 6.37-2164.88), followed by cryotherapy (OR 16.81, 95% CI 4.13-68.54), podophyllotoxin (OR 10.24, 95% CI 3.36-31.21), and potassium hydroxide (KOH) (OR 10.02, 95% CI 4.64-21.64). Data on adverse effects were too scarce for quantitative synthesis.
Conclusions:
Ingenol mebutate, cryotherapy, podophyllotoxin, and KOH were more effective than the other interventions in achieving complete clearance, but safety concerns regarding ingenol mebutate have recently been reported. Due to the possibility of spontaneous resolution, observation is also justified for asymptomatic infection. Factors including adverse effects, cost, patient preference, and medical accessibility should be considered.
Dedicamos este relato a todos aquellos que día a día luchan por ser visibilizados: a las mujeres en general y a las cirujanas en particular; a los hispano parlantes, principalmente de lugares que no pertenecen al denominado primer mundo; a los que producen conocimiento en países no hegemónicos; a los que tienen un acceso dificultoso al sistema de salud y, en especial, a los que padecen infecciones sexualmente transmisibles y no encuentran a un profesional integralmente preparado para atenderlos.
Covering: up to 2022Podophyllotoxin (PTOX, 1), a kind of aryltetralin-type lignan, was first discovered in the plant Podophyllum peltatum and its structure was clarified by W. Borsche and J. Niemann in 1932. Due to its potent anti-cancer and anti-viral activities, it is considered one of the molecules most likely to be developed into modern drugs. With the increasing market demand and insufficient storage of natural resources, it is crucial to expand the sources of PTOXs. The original extraction method from plants has gradually failed to meet the requirements, and the biosynthesis and total synthesis have become the forward-looking alternatives. As key enzymes in the biosynthetic pathway of PTOXs and their catalytic mechanisms being constantly revealed, it is possible to realize the heterogeneous biosynthesis of PTOXs in the future. Chemical and chemoenzymatic synthesis also provide schemes for strictly controlling the asymmetric configuration of the tetracyclic core. Currently, the pharmacological activities of some PTOX derivatives have been extensively studied, laying the foundation for clinical candidate drugs. This review focuses primarily on the latest research progress in the biosynthesis, total synthesis, and pharmacological activities of PTOX and its derivatives, providing a more comprehensive understanding of these widely used compounds and supporting the future search for clinical applications.
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.
Although molluscum contagiosum (MC) is a common infectious dermatosis that is self-resolving, treatment can resolve discomfort and decrease the risk of autoinoculation and infection to others because it is transmitted through direct skin contact. This systematic review evaluates the efficacy of topical treatments for MC. A PubMed search following PRISMA guidelines was performed to find randomized-controlled trials of MC treatment. The search yielded 129 publications, but only 15 studies published between 1994-2020 were found to fit the inclusion criteria. Treatment modalities included: podophyllotoxin, imiquimod, sodium nitrite, myrtle leaf extract, phenol, Salatac Gel (salicylic acid with lactic acid), potassium hydroxide, cantharidin, SB206 (berdazimer sodium gel), and VP-102 (cantharidin). Outcomes were extracted from the literature and subsequent quality and risk of bias assessments were performed. All treatments were more efficacious than the control except cantharidin, KOH, and imiquimod, which had varying degrees of efficacy throughout studies. Overall, studies were of sufficient quality and had low risk of bias, but they had small sample sizes and lacked adequate explanation of statistical analysis. Current first-line treatment entails mechanical methods such as cryotherapy and curettage may be frightening to children with MC, so the development and assessment of topical treatments allows alternative efficacious techniques.
Phytocompounds are chemicals derived from plants and their metabolites. Compiled by millennia of tradition in various cultures worldwide, phytocompounds are the origin of a great number of medications we use daily in modern medicine. Many household foods and plants are common home remedies for a variety of illnesses including infections such as garlic (Allium sativum) and ginger (Zingiber officinale). With burgeoning resistance in all pathogens of the skin, phytocompounds offer promising therapies that may be effective yet nontoxic. In this chapter, we discuss the botanical species and their metabolites along with their various mechanisms of action supporting their role against resistant bacteria, fungi, and viruses involved in infections of the skin. These include synergistic potentiation of established antimicrobials, antibiofilm properties, and the overall efficacy of botanical species against various microbes. While agents such as essential oils have been well studied in vitro, plant extracts and their metabolites critically require more clinical trials to verify their efficacy in the real world. In addition, we discuss current research trends along with challenges facing phytocompounds in a world of increasing regulations and barriers to development.
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.
The female genitalia are affected by specific dermatoses, such as lichen sclerosus and lichen planus, but are also involved as part of more widespread cutaneous disease. This chapter covers the clinical features and management of dermatoses, infections and pre‐malignant and malignant disease of the female genitalia and highlights the issues that are specific to the region.
Molluscum contagiosum (MC) is the most common poxvirus infection circulating in humans. Prevalence/incidence studies indicate the infection is frequently seen in general practice with a case incidence rate of 1295/100 000 person‐years in the UK. Molluscum contagiosum virus (MCV) seroprevalences vary between 6% and 77% in different geographical locations and subpopulations, suggesting many infections are either subclinical or not reported. MC is normally self‐limiting with few lesions disappearing spontaneously without need for treatment. Extensive cases are seen in immunosuppressed individuals and those with atopic dermatitis. MC can persist for years, and treatment should be considered in those cases.
Molluscum contagiosum (MC) is a viral infection disease of the skin and mucosal membranes, characterized by small, skin colored, discrete, dome‐shaped, pearly papules with a central dell or depression that are usually located on the head, neck, trunk and anogenital region. The lesions are caused by the molluscum contagiosum virus, which replicates in the epidermis and enters the skin from a small skin defect leading to impaired skin barrier function or from contaminated items. Molluscum contagiosum has a worldwide distribution and commonly infects school‐aged healthy children, sexually active adults and immuncomprimised patients that may persist for many months before spontaneous resolution. By the characteristic appearance of the lesions, diagnosis is usually made by clinical findings without any laboratory testing. Although molluscum contagiosum usually resolves spontaneously, there are several reasons to treat the infection, such as unattractiveness, pruritus, or its high recurrence and spreading rate. There are no FDA approved specific treatments for molluscum contagiosum infection in immunocompetent individuals yet.
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.
Molluscum contagiosum, ook wel ‘kinderwrat’ of ‘waterwrat’ genoemd, is een huidaandoening die wordt gekenmerkt door wasachtige papels met een centrale indeuking (delle), meestal niet groter dan 2-5 mm, die neigt tot spontane genezing zonder littekenvorming.
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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