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#232 Muscling out molluscum contagiosum: Which treatments work?


CLINICAL QUESTION
QUESTION CLINIQUE
How effective are commonly used therapies for molluscum contagiosum? 


BOTTOM LINE
RÉSULTAT FINAL
If treated, molluscum contagiosum will have complete clearance of lesions within 3 months for ~15% given placebo, ~30% given cantharidin 0.7%, and 50-80% given potassium hydroxide 10-15%, cryotherapy or perhaps curettage (very limited evidence). Imiquimod is not effective.  



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EVIDENCE
DONNÉES PROBANTES
One systematic review1 and three recent randomized controlled trials2-4 (RCTs) evaluated complete resolution of lesions in immunocompetent pediatric patients within 3 months of starting treatment: 
  • Potassium hydroxide 10-15% once or twice daily: 
    • Versus placebo (3 RCTs, 163 patients; meta-analyzed by PEER):1,3,4 49% versus 17% placebo, Number Needed to Treat (NNT)=4. 
    • Versus curettage (1 RCT, 34 patients):1 81% versus 88% curettage, not statistically different.  
    • Versus cryotherapy once/week for 4-6 weeks (2 RCTs, 150 patients, 1 RCT including children and adults; meta-analyzed by PEER):1,4 81% versus 85% cryotherapy, not statistically different. 
  • Cantharidin 0.7% solution applied 2-5 times over 6-8 weeks: 
    • Versus placebo (2 RCTs, 123 patients; meta-analyzed by PEER):1,2 32% versus 10% placebo, NNT=5. 
  • Imiquimod 5% 3-7 times/week: 
    • Versus placebo (4 RCTs, 850 patients): 15% versus 12% placebo, not statistically different.1 
    • Versus potassium hydroxide 10% (2 RCTs, 67 patients):1 53% versus 82% potassium hydroxide, number needed to harm (NNH)=4.  
    • Versus cryotherapy once/week (1 RCT, 74 patients):1 59% versus 100% cryotherapy, NNH=3. 
  • Adverse Events: 
    • Site reaction: imiquimod versus placebo (3 RCTs, 827 patients): 36% versus 26% placebo, NNH=11.1 
    • Burning sensation: 1 RCT 53% potassium hydroxide versus 12% placebo, NNH=3 (pain/stinging not statistically different).3 
Context: 
  • Limitations: Patients did not have or were not treated for genital lesions. 
  • Potassium hydroxide may cause chemical burns with improper use; should be applied sparingly, directly to lesion. When redness appears, discontinue use and wait for lesion to heal.5 
  • Estimated incidence of molloscum contagiosum is 12-14 cases per 1000 children per year.6 
  • Molluscum contagiosum is benign; the majority of cases resolve within a year without treatment.7 
    • In some cases, treatment may be preferable to improve quality of life and limit the risk of transmission.8 
  • Cryotherapy, cantharidin and curettage require in-office treatment. 


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Author(s)
Auteur(s)
  • Danielle Perry BScN RN
  • G. Michael Allan MD CCFP
  • Nicolas Dugré PharmD MSc

1. Van der Wouden JC, van der Sande R, Kruithof EF, et al. Cochrane Database Syst Rev. 2017; 5:CD004767

2. Guzman A, Schairer D, Garelik J, et al. Int J Dermatol. 2018 ;57(8):1001-6.

3. Teixidó C, Díez O, Marsal JR, et al. Pediatr Dermatol. 2018; 35(3):336-42.

4. Giner-Soriano M, Teixidó C, Marsal J, et al. J Dermatolog Treat. 2019:1-7.

5. ACM Laboratoire Dermatologique. Treatment of molloscum contagiosum. Available at: https://www.labo-acm.com/en/molluscum-contagiosum/58-molutrex.html. Last accessed February 26, 2019.

6. Qureshi A, Zeb M, Jalal-Ud-Din M, et al. J Ayub Med Coll Abbottabad. 2016; 28(2): 382-385.

7. Olsen JR, Gallacher J, Piguet V, et al. Family Practice. 2014;31(2): 130-6.

8. Olsen JR, Gallacher J, Finlay AY, et al. Lancet Infect Dis. 2015;15:190-5.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.