Treating Molluscum Contagiosum Infection? 'Natural resolution' — that is, no treatment — 'remains a reasonable approach'

Original article by: by John Jesitus, Dermatology Times

The dearth of evidence regarding treatments for non-genital molluscum contagiosum leaves physicians uncertain if any interventions work better than allowing the infection to resolve itself, according to researchers.

“The overall conclusions have hardly changed. We found no strong evidence either for or against the most commonly used treatment options for molluscum contagiosum. Allowing for natural resolution of the infection remains a reasonable approach,” wrote Johannes C. van der Wouden, PhD, the Amsterdam Public Health Research Institute, and colleagues in a review in JAMA Dermatology.

“We found some evidence to suggest that 10% potassium hydroxide is more effective than saline; 5% solution of potassium hydroxide is favored compared to 2.5% solution of potassium hydroxide; 10% povidone iodine solution plus 50% salicylic acid plaster is favored compared to salicylic acid plaster alone; and homeopathic calcarea carbonica is favored compared to placebo.”

In patients without immune deficiency, resolution of molluscum contagiosum can take several months, or in extreme cases, 3 to 4 years, van der Wouden et al noted, adding, however, that patients may desire treatment for social or cosmetic reasons, or to avoid scratching or spreading the infection.

Updating a 2009 review, the authors searched the Cochrane Skin Group Specialized Register, Central, Medline, Lilacs, and Embase through July 2016. They also searched six trial registries, scoured the included studies for additional relevant references and queried pharmaceutical companies and experts to identify further relevant randomized controlled trials. The search identified 11 new studies, making an evaluable pool of 22 studies with a total of 1,650 participants.

Among the 11 new studies were four never-published randomized controlled trials of imiquimod, which collectively provided moderate-quality evidence for lack of effect of 5% imiquimod compared with placebo in the short, medium, and long term. Pooling the results of the four unpublished studies with a total of 544 patients and treatment times between 8 and 16 weeks showed a clinical cure rate of 14.5% (79 patients) for imiquimod, versus 11.8% (36 patients) for placebo (pooled risk difference: 4%; 95% CI: -1% to 8%).

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