Interventions for cutaneous molluscum contagiosum

Johannes C van der Wouden; Renske van der Sande; Lisette WA van Suijlekom‐Smit; Marjolein Berger; Christopher C Butler; Sander Koning

doi:10.1002/14651858.CD004767.pub3

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Figure 1

Risk of bias table: review authors' judgements about each methodological quality item for each included study.

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Analysis 1.1

Comparison 1 Topical: 10% Australian lemon myrtle oil vs. vehicle (olive oil), Outcome 1 Complete clearance or > 90% reduction after 3 weeks.

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Analysis 2.1

Comparison 2 Topical: 5% imiquimod vs. vehicle, Outcome 1 Complete clearance after 4 weeks.

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Analysis 2.2

Comparison 2 Topical: 5% imiquimod vs. vehicle, Outcome 2 Partial clearance after 4 weeks.

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Analysis 2.3

Comparison 2 Topical: 5% imiquimod vs. vehicle, Outcome 3 Complete clearance after 12 weeks.

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Analysis 2.4

Comparison 2 Topical: 5% imiquimod vs. vehicle, Outcome 4 Partial clearance after 12 weeks.

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Analysis 3.1

Comparison 3 Topical: 10% benzoyl peroxide cream vs. 0.05% tretinoin cream (ITT), Outcome 1 Free of lesions after 6 weeks.

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Analysis 4.1

Comparison 4 Topical: 10% KOH vs. saline, Outcome 1 Clinical cure at medium‐term follow‐up (3 months).

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Analysis 5.1

Comparison 5 Topical: 10% povidone iodine and 50% salicylic plaster vs. 10% povidone iodine alone, Outcome 1 Clinical cure at end of study (duration unknown).

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Analysis 6.1

Comparison 6 Topical: 10% povidone iodine and 50% salicylic acid plaster vs. 50% salicylic plaster alone, Outcome 1 Clinical cure at end of study (duration unknown).

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Analysis 7.1

Comparison 7 Topical: 10% povidone iodine vs. 50% salicylic acid plaster, Outcome 1 Clinical cure at end of study (duration unknown).

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Analysis 8.1

Comparison 8 Topical: 5% sodium nitrite in 5% salicylic acid vs. 5% salicylic acid alone, Outcome 1 Clinical cure at medium‐term follow‐up (3 months).

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Analysis 9.1

Comparison 9 Topical: 10% phenol/70% alcohol vs. 70% alcohol (ITT), Outcome 1 Complete clearance at end of study (max 6 months).

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Analysis 10.1

Comparison 10 Topical: 12% salicylic acid vs. 70% alcohol (ITT), Outcome 1 Complete clearance at end of study (6 months max).

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Analysis 11.1

Comparison 11 Topical: 12% salicylic acid vs. 10% phenol/70% alcohol (ITT), Outcome 1 Complete clearance at end of study (max 6 months).

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Analysis 12.1

Comparison 12 Systemic: cimetidine vs. placebo, Outcome 1 Clinical cure at medium‐term follow‐up (4 months).

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Analysis 13.1

Comparison 13 Systemic: calcarea carbonica vs. placebo, Outcome 1 Improvement at end of study (duration unknown).

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Table 1. Treatment modalities and examples of references

Treatment class	Treatment modality	Included studies	Other studies
Surgical treatments	Cryotherapy		Caballero 1996; Barton 2002; Salmanpour 2006
	Curettage	Hanna 2006	de Waard 1990
	Curettage with punch		Quan 2000
	Electric cauterisation		He 2001
	Physical expression (squeezing)		Weller 1999
	Pricking		Wishart 1903
	Pulsed dye laser		Hammes 2001
Topical treatments	Acidified nitrite	Ormerod 1999	Gräfe 2000
	Australian lemon myrtle oil	Burke 2004
	Benzoyl peroxide	Saryazdi 2004
	Bromogeramine		He 2001
	Cantharidin	Hanna 2006	Funt 1961; Funt 1979; Silverberg 2000; Ross 2004
	Cidofovir		Davies 1999; Zabawski 1999; Toro 2000
	Diphencyprone		Kyu 1993; Kang 2005
	Griseofulvin		Salmanpour 2006
	Imiquimod	Theos 2004; Hanna 2006	Syed 1998; Liota 2000; Barba 2001; Skinner 2002; Bayerl 2003; Hengge 2003
	Milkweed		Behl 1970
	Povidone iodine + salicylic acid	Ohkuma 1990
	Phenol	Leslie 2005	Weller 1999
	Podophyllotoxin (HIV patients)		Syed 1994; Teilla‐Hamel 1996; Markos 2001
	Potassium hydroxide	Bazza; Short 2006	Romiti 1999; Romiti 2000
	Retinoic acid		Hund 1975
	Salicylic acid	Ohkuma 1990; Leslie 2005; Hanna 2006
	Salicylic acid combined with sodium nitrite	Ormerod 1999
	Silver nitrate		Niizeki 1999
	Tretinoin	Saryazdi 2004
	Yellow oxide of mercury		Davis 1896
Systemic treatments	Cimetidine	Antony 2001	Dohil 1996; Cunningham 1998; Sharma 1998; Yasher 1999
	Calcarea carbonica (homeopathy)	Manchanda 1997b	Manchanda 1997a
	Griseofulvin		Singh 1977
Combinations of above	Potassium iodide followed by X‐rays		Cope 1915

Table 1. Treatment modalities and examples of references

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Comparison 1. Topical: 10% Australian lemon myrtle oil vs. vehicle (olive oil)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Complete clearance or > 90% reduction after 3 weeks Show forest plot	1	31	Risk Ratio (M‐H, Fixed, 95% CI)	17.88 [1.13, 282.72]

Comparison 1. Topical: 10% Australian lemon myrtle oil vs. vehicle (olive oil)

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Comparison 2. Topical: 5% imiquimod vs. vehicle

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Complete clearance after 4 weeks Show forest plot	1	23	Risk Ratio (M‐H, Fixed, 95% CI)	4.62 [0.25, 86.72]

2 Partial clearance after 4 weeks Show forest plot	1	23	Risk Ratio (M‐H, Fixed, 95% CI)	13.85 [0.88, 217.26]

3 Complete clearance after 12 weeks Show forest plot	1	23	Risk Ratio (M‐H, Fixed, 95% CI)	3.67 [0.48, 28.00]

4 Partial clearance after 12 weeks Show forest plot	1	23	Risk Ratio (M‐H, Fixed, 95% CI)	3.67 [0.98, 13.67]

Comparison 2. Topical: 5% imiquimod vs. vehicle

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Comparison 3. Topical: 10% benzoyl peroxide cream vs. 0.05% tretinoin cream (ITT)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Free of lesions after 6 weeks Show forest plot	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	2.2 [1.01, 4.79]

Comparison 3. Topical: 10% benzoyl peroxide cream vs. 0.05% tretinoin cream (ITT)

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Comparison 4. Topical: 10% KOH vs. saline

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical cure at medium‐term follow‐up (3 months) Show forest plot	2	60	Risk Ratio (M‐H, Random, 95% CI)	1.68 [0.36, 7.75]

Comparison 4. Topical: 10% KOH vs. saline

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Comparison 5. Topical: 10% povidone iodine and 50% salicylic plaster vs. 10% povidone iodine alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical cure at end of study (duration unknown) Show forest plot	1	25	Risk Ratio (M‐H, Random, 95% CI)	1.67 [0.85, 3.30]

Comparison 5. Topical: 10% povidone iodine and 50% salicylic plaster vs. 10% povidone iodine alone

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Comparison 6. Topical: 10% povidone iodine and 50% salicylic acid plaster vs. 50% salicylic plaster alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical cure at end of study (duration unknown) Show forest plot	1	30	Risk Ratio (M‐H, Random, 95% CI)	1.43 [0.95, 2.16]

Comparison 6. Topical: 10% povidone iodine and 50% salicylic acid plaster vs. 50% salicylic plaster alone

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Comparison 7. Topical: 10% povidone iodine vs. 50% salicylic acid plaster

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical cure at end of study (duration unknown) Show forest plot	1	15	Risk Ratio (M‐H, Random, 95% CI)	0.86 [0.38, 1.95]

Comparison 7. Topical: 10% povidone iodine vs. 50% salicylic acid plaster

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Comparison 8. Topical: 5% sodium nitrite in 5% salicylic acid vs. 5% salicylic acid alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical cure at medium‐term follow‐up (3 months) Show forest plot	1	30	Risk Ratio (M‐H, Random, 95% CI)	3.5 [1.23, 9.92]

Comparison 8. Topical: 5% sodium nitrite in 5% salicylic acid vs. 5% salicylic acid alone

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Comparison 9. Topical: 10% phenol/70% alcohol vs. 70% alcohol (ITT)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Complete clearance at end of study (max 6 months) Show forest plot	1	77	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.56, 1.56]

Comparison 9. Topical: 10% phenol/70% alcohol vs. 70% alcohol (ITT)

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Comparison 10. Topical: 12% salicylic acid vs. 70% alcohol (ITT)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Complete clearance at end of study (6 months max) Show forest plot	1	73	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.81, 2.02]

Comparison 10. Topical: 12% salicylic acid vs. 70% alcohol (ITT)

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Comparison 11. Topical: 12% salicylic acid vs. 10% phenol/70% alcohol (ITT)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Complete clearance at end of study (max 6 months) Show forest plot	1	78	Risk Ratio (M‐H, Fixed, 95% CI)	1.37 [0.86, 2.17]

Comparison 11. Topical: 12% salicylic acid vs. 10% phenol/70% alcohol (ITT)

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Comparison 12. Systemic: cimetidine vs. placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical cure at medium‐term follow‐up (4 months) Show forest plot	1	19	Risk Ratio (M‐H, Random, 95% CI)	1.1 [0.43, 2.84]

Comparison 12. Systemic: cimetidine vs. placebo

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Comparison 13. Systemic: calcarea carbonica vs. placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Improvement at end of study (duration unknown) Show forest plot	1	20	Risk Ratio (M‐H, Random, 95% CI)	5.57 [0.93, 33.54]

Comparison 13. Systemic: calcarea carbonica vs. placebo

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