Interventions for cutaneous molluscum contagiosum

 

Abstract

Background

Molluscum contagiosum is a common skin infection, caused by a pox virus. The infection will usually resolve within months in people with a normal immune system. Many treatments have been used for molluscum contagiosum but a clear evidence base supporting them is lacking.

This is an updated version of the original Cochrane Review published in Issue 2, 2006.

Objectives

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

Search methods

In June 2009 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 2, 2009), MEDLINE, EMBASE, and LILACS. We also searched ongoing trials registers, reference lists, and contacted pharmaceutical companies and experts in the field.

Selection criteria

We investigated randomised controlled trials (RCTs) for the treatment of molluscum contagiosum. We excluded trials on sexually transmitted molluscum contagiosum and in people with lowered immunity (including those with HIV infection).

Data collection and analysis

Two authors independently selected studies, assessed methodological quality, and extracted data from selected studies.

Main results

Eleven studies, with a total number of 495 participants, examined the effects of topical (9 studies), systemic, and homoeopathic interventions (1 study each). Limited evidence was found for the efficacy of 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); for Australian lemon myrtle oil compared to its vehicle, olive oil (RR 17.88, 95% CI 1.13 to 282.72); and for benzoyl peroxide cream compared to tretinoin (RR 2.20, 95% CI 1.01 to 4.79). No statistically significant differences were found for 10 other comparisons, most of which addressed 2 topical treatments.

Study limitations included no blinding (four studies), many dropouts (three studies), and no intention-to-treat analysis; small study sizes may have led to important differences being missed. None of the evaluated treatment options were associated with serious adverse effects.

Authors' conclusions

No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. The update identified six new studies, most of them reporting on interventions not included in the original version. However, the conclusions of the review did not change.

 

Plain language summary

There is not enough evidence to show that any particular treatment is effective for treating molluscum infection.

Molluscum contagiosum, in healthy people, is a self limiting, relatively harmless viral skin infection. It affects mainly children and adolescents. It occurs worldwide but is much more frequent in certain geographic areas with warm climates. Molluscum contagiosum usually presents as single or multiple pimples filled with fluid. People may seek treatment for social and aesthetic reasons and because of concerns about spreading the disease to others. Treatment is intended to speed up the healing process. Eleven studies with 495 patients were included in this review. This review found that many common treatments for molluscum, such as physical destruction, have not been adequately evaluated. Several of the treatments that we studied are not part of daily practice. Limitations of several of these studies were: small numbers of patients, the investigators were not blinded, and patients who did not complete the study (which were numerous in some studies) were not included in the analysis. None of the evaluated treatment options were associated with serious adverse effects.
Since most lesions will resolve within months, molluscum contagiosum can be left to heal naturally unless better evidence for the superiority of other treatment options emerges.

 

摘要

背景

皮膚傳染性軟疣的治療

傳染性軟疣是一種由病毒造成的常見皮膚傳染，在有正常免疫系統的人身上通常數個月內就會復原。有許多治療傳染性軟疣的方式被推薦，但是支持他們的證據基礎並不清楚。

目標

評估在健康的人身上皮膚, 非生殖器官的傳染性軟疣治療策略的效果，包含等待自然復原。

搜尋策略

我們搜尋了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. 我們也同時搜尋了參考文獻,並且和藥商及這個領域的專家們接觸。

選擇標準

分析調查治療傳染性軟疣的隨機受控試驗。有關性交引起傳染性軟疣和有免疫低下的人 (包括那些後天免疫不全病毒 (HIV) 感染的人) 的試驗被排除。

資料收集與分析

研究的選擇，研究方法品質的評估，以及從選擇的研究中擷取實驗資料，由二位作者獨立執行。

主要結論

11項研究，總共495個受試者，審查了局部 (9項研究) ，全身性和順勢介入療法 (各1項) 的作用。有限的證據發現硝酸鈉 (sodium nitrite) 與水楊酸 (salicylic acid) 並用與單獨使用水楊酸比較 (風險比率 (RR) 3.50， 95% 信賴區間 (CI) 1.23到9.92) 。針對澳洲檸檬馬鞭草油和其賦形劑比較 (風險比率 (RR) 17.88， 95% 信賴區間 (CI) 1.13到282.72); 至於過氧化二苯甲醯乳霜和維生素A酸tretinoin比較 (風險比率 (RR) 2.20， 95% 信賴區間 (CI) 1.01到4.79) 。在另外10個比較性的研究中，大部份的研究都是以2種外用療法互相比較，並沒有統計學上顯著的差異被發現。研究限制包括不矇蔽 (4項研究) ，許多退出 (3項研究) ，與沒有意圖治療分析; 小的研究也許導致一些重要的區別被忽視。被評估的治療選擇都沒有嚴重的副作用。

作者結論

沒有單一的治療傳染性軟疣的方式有令人信服的效果。目前最新已確認的6個新研究中，大部分發表的介入性治療並沒有包括在原本的版本中。然而，回顧的結論並沒有因此改變。

翻譯人

本摘要由馬偕醫院郭映伶翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

沒有足夠的證據顯示特別有效的治療傳染性軟疣的方式。傳染性軟疣在健康的人身上是一種自限性的疾病，是相對無傷害的皮膚病毒感染。主要發生在小孩跟青少年身上。它廣佈於世界各地，但特別好發於特定溫暖氣候的地域。傳染性軟疣，臨床上通常以單一個或多個填充液體的丘疹表現。人們會因社會和審美原因以及怕疾病傳染到其他人，而尋找治療。治療的目的是要加速癒合的過程。這個回顧總共包含了11個研究，495個病人。這回顧發現軟疣的許多常見的治療，例如物理破壞，未被適當地評估。許多研究的治療是沒辦法天天施行的。許多研究的限制如下:病人數目少，研究員不是盲的，以及沒有完成整個研究的病人 (在一些研究中為數不少) ，沒有被包含在統計分析中。被評估的治療選擇都沒有嚴重的副作用。因為多數的病灶在幾個月內會自行緩解，傳染性軟疣可以被放著自然地癒合，除非有證據證明有更好的治療選擇出現。