Interventions for cutaneous molluscum contagiosum.
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.


OBJECTIVE
To assess the effects of management strategies (including waiting for natural resolution) for cutaneous, non-genital molluscum contagiosum in healthy people.


METHODS
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.


METHODS
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.


METHODS
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.


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.


CONCLUSIONS
No single intervention has been shown to be convincingly effective in treating molluscum contagiosum.
van der Wouden
J C
JC
University Medical Center Rotterdam, Department of General Practice, Erasmus MC, Room Ff304, PO Box 1738, Rotterdam, Netherlands, 3000 DR. j.vanderwouden@erasmusmc.nl
Menke
J
J
Gajadin
S
S
Koning
S
S
Tasche
M J A
MJ
van Suijlekom-Smit
L W A
LW
Berger
M Y
MY
Butler
C C
CC
D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D002927:Cimetidine / Q000627:therapeutic use; D006801:Humans; D006878:Hydroxides / Q000627:therapeutic use; D008976:Molluscum Contagiosum / Q000188:drug therapy / Q000628:therapy*; D017680:Potassium Compounds / Q000627:therapeutic use; D011206:Povidone-Iodine / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012075:Remission, Spontaneous; D020156:Salicylic Acid / Q000627:therapeutic use; D012977:Sodium Nitrite / Q000627:therapeutic use
D000891:Anti-Infective Agents, Local; D006878:Hydroxides; D017680:Potassium Compounds; D002927:Cimetidine; D011206:Povidone-Iodine; D012977:Sodium Nitrite; D020156:Salicylic Acid; C029943:potassium hydroxide