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Intervensi untuk moluskum contagiosum kutaneous

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Referencias

Al‐Mutairi 2010 {published data only}

Al‐Mutairi N, Al‐Doukhi A, Al‐Farag S, Al‐Haddad A. Comparative study on the efficacy, safety, and acceptability of imiquimod 5% cream versus cryotherapy for molluscum contagiosum in children. Pediatric Dermatology 2010;27(4):388‐94. [CENTRAL: CN‐00760650; PUBMED: 19804497]CENTRAL

Antony 2001 {published data only}

Antony F, Cliff S, Ahmad A, Holden C. Double‐blind placebo‐controlled study of oral cimetidine treatment for molluscum contagiosum. British Journal of Dermatology 2001;145(Suppl 59):126. [CENTRAL: CN‐00430863]CENTRAL

Bazza 2007 {unpublished data only}

Bazza MA, Ryatt KS. Sterile normal 0.9% saline as a effective 5% potassium hydroxide in treatment of molluscum contagiosum, and safer (title incomplete). Unpublished manuscript2007:1‐4. [CENTRAL: CN‐00747643]CENTRAL

Burke 2004 {published data only}

Burke BE, Baillie JE, Olson RD. Essential oil of Australian lemon myrtle (Backhousia citriodora) in the treatment of molluscum contagiosum in children. Biomedecine & Pharmacotherapie [Biomedicine & Pharmacotherapy] 2004;58(4):245‐7. [CENTRAL: CN‐00489728; PUBMED: 15183850]CENTRAL

Chathra 2015 {published data only}

Chathra N, Sukumar D, Bhat RM, Kishore BN, Martis J, Kamath G, et al. A comparative study of 10% KOH solution and 5% imiquimod cream for the treatment of molluscum contagiosum in the pediatric age group. Indian Dermatology Online Journal 2015;6(2):75–80. [CTRI/2013/08/003941; PUBMED: 25821725]CENTRAL

Coloe Dosal 2014 {published data only}

Coloe Dosal J, Stewart PW, Lin JA, Williams CS, Morrell DS. Cantharidin for the treatment of molluscum contagiosum: a prospective, double‐blinded, placebo‐controlled trial. Pediatric Dermatology 2014;31(4):440‐9. [CENTRAL: CN‐00999446; PUBMED: 22897595]CENTRAL

Eichenfield 2005 {unpublished data only}

EIchenfield LF. Phase‐III double‐blind vehicle‐controlled study of imiquimod cream 5% for the treatment of molluscum contagiosum in pediatric subjects (3M Pharmaceuticals study number 1494‐IMIQ). Unpublished study report. 3M Pharmaceuticals, St. Paul (MN, USA)2005. CENTRAL

Handjani 2014 {published data only}

Handjani F, Behazin E, Sadati MS. Comparison of 10% potassium hydroxide solution versus cryotherapy in the treatment of molluscum contagiosum: an open randomized clinical trial. Journal of Dermatological Treatment 2014;25(3):249‐50. [CENTRAL: CN‐00961439; PUBMED: 23924070]CENTRAL

Hanna 2006 {published data only}

Hanna D, Hatami A, Powell J, Marcoux D, Maari C, Savard P, et al. A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children. Pediatric Dermatology 2006;23(6):574‐9. [CENTRAL: CN‐00609029; PUBMED: 17156002]CENTRAL
McCuaig CC, Hatami A, Powell J, Maari C, Marcoux D, Thibeault H. Mollusca contagiosa: what treatment to use when?. Journal of the European Academy of Dermatology and Venereology : JEADV 2005;19(Suppl 2):8. [CENTRAL: CN‐00602169]CENTRAL

Leslie 2005 {published data only}

Leslie KS, Dootson G, Sterling JC. Does treatment of molluscum contagiosum affect clearance?. British Journal of Dermatology 2004;151(Suppl 68):67. [CENTRAL: CN‐00487868]CENTRAL
Leslie KS, Dootson G, Sterling JC. Topical salicylic acid gel as a treatment for molluscum contagiosum in children. Journal of Dermatological Treatment 2005;16(5‐6):336‐40. [CENTRAL: CN‐00554512; PUBMED: 16428156]CENTRAL

Machado 2010 {published data only}

Machado RB, Leal TF, Bonfa R, Werlang ME, Blessmann Weber M. Molluscum contagiosum in children: comparative treatments [Molusco contagioso em crianças: tratamentos comparativos]. Surgical & Cosmetical Dermatology 2010;2:272‐5. CENTRAL

Manchanda 1997b {published data only}

Manchanda RK, Mehan N, Bahl R, Atey R. Double blind placebo controlled clinical trials of homeopathic medicines in warts and molluscum contagiosum. Central Council of Research in Homeopathy Quarterly Bulletin 1997;19(3&4):25‐9. [CENTRAL: CN‐00478663]CENTRAL

Markum 2012 {published data only}

Markum E, Baillie J. Combination of essential oil of Melaleuca alternifolia and iodine in the treatment of molluscum contagiosum in children. Journal of Drugs in Dermatology 2012;11(3):349‐54. [CENTRAL: CN‐00880968; PUBMED: 22395586]CENTRAL

Ohkuma 1990 {published data only}

Ohkuma M. Molluscum contagiosum treated with iodine solution and salicylic acid plaster. International Journal of Dermatology 1990;29(6):443‐5. [CENTRAL: CN‐00269315; PUBMED: 2397974]CENTRAL

Ormerod 1999 {published data only}

Ormerod AD, White MI, Shah SA, Benjamin N. Molluscum contagiosum effectively treated with a topical acidified nitrite, nitric oxide liberating cream. British Journal of Dermatology 1999;141(6):1051‐3. [CENTRAL: CN‐00274687; PUBMED: 10606851]CENTRAL

Paller 2005a {unpublished data only}

Paller A. Double‐blind vehicle‐controlled study of imiquimod cream 5% in pediatric subjects with molluscum contagiosum to evaluate safety and efficacy of daily dosing during 8 weeks of treatment (3M Pharmaceuticals study number 1490‐IMIQ). Unpublished study report. 3M Pharmaceuticals, St. Paul (MN, USA) July 2005 (amendment April 2006). CENTRAL

Paller 2005b {unpublished data only}

Paller A. Phase‐III double‐blind vehicle‐controlled study of imiquimod cream 5%, for the treatment of molluscum contagiosum in pediatric subjects (3M Pharmaceuticals study number 1495‐IMIQ). Unpublished study report. 3M Pharmaceuticals, St. Paul (MN, USA)November 2005. CENTRAL

Saryazdi 2004 {published data only}

Saryazdi S. The comparative efficacy of benzoyl peroxide 10% cream and tretinoin 0.05% cream in the treatment of molluscum contagiosum. Pediatric Dermatology 2004;21(3):399. [CENTRAL: CN‐00520460]CENTRAL

Seo 2010 {published data only}

Seo SH, Chin HW, Jeong DW, Sung HW. An open, randomized, comparative clinical and histological study of imiquimod 5% cream versus 10% potassium hydroxide solution in the treatment of molluscum contagiosum. Annals of Dermatology 2010;22(2):156‐62. [CENTRAL: CN‐01046394]CENTRAL

Short 2006 {published and unpublished data}

Short KA, Fuller LC, Higgins EM. Double‐blind randomized placebo‐controlled trial of the use of topical potassium hydroxide in the treatment of molluscum contagiosum. British Journal of Dermatology 2002;147(Suppl 62):95. [CENTRAL: CN‐00487907; CENTRAL: CN‐00406990]CENTRAL
Short KA, Fuller LC, Higgins EM. Double‐blind, randomised, placebo‐controlled trial of the use of topical 10% potassium hydroxide solution of molluscum contagiosum. Unpublished manuscript. CENTRAL
Short KA, Fuller LC, Higgins EM. Double‐blind, randomized, placebo‐controlled trial of the use of topical 10% potassium hydroxide solution in the treatment of molluscum contagiosum. Pediatric Dermatology 2006;23(3):279‐81. [CENTRAL: CN‐00570792; PUBMED: 16780480]CENTRAL

Theos 2004 {published data only}

Theos AU, Cummins R, Silverberg NB, Paller AS. Effectiveness of imiquimod cream 5% for treating childhood molluscum contagiosum in a double‐blind, randomized pilot trial. Cutis 2004;74(2):134‐8,141‐2. [CENTRAL: CN‐00491567; PUBMED: 15379366]CENTRAL

Uçmak 2013 {published data only}

Uҫmak D, Akkurt MZ, Kacar SD, Sula B, Arica M. Comparative study of 5% and 2.5% potassium hydroxide solution for molluscum contagiosum in children. Cutaneous and Ocular Toxicology 2014;33(1):54‐9. [CENTRAL: CN‐00982389; PUBMED: 23713782]CENTRAL

Arican 2006 {published data only}

Arican O. Topical treatment of molluscum contagiosum with imiquimod 5% cream in Turkish children. Pediatrics International 2006;48(4):403‐5. [PUBMED: 16911087]CENTRAL

Barton 2002 {published data only}

Barton SE, Chard S. Facial molluscum: treatment with cryotherapy and podophyllotoxin. International Journal of STD & AIDS 2002;13(4):277‐8. [PUBMED: 11963912]CENTRAL

Bayerl 2003 {published data only}

Bayerl C, Feller G, Goerdt S. Experience in treating molluscum contagiosum in children with imiquimod 5% cream. British Journal of Dermatolology 2003;149(Suppl 66):25‐9. [PUBMED: 14616342]CENTRAL

Caballero 1996 {published data only}

Caballero Martinez F, Plaza Nohales C, Perez Canal C, Lucena Martin MJ, Holgado Catalán M, Olivera Cañadas G. Cutaneous cryosurgery in family medicine: dimethyl ether‐propane spray versus liquid nitrogen. Atencion Primaria 1996;18(5):211‐6. [PUBMED: 8963007]CENTRAL

Can 2014 {published data only}

Can B, Topaloğlu F, Kavala M, Turkoglu Z, Zindancı I, Sudogan S. Treatment of pediatric molluscum contagiosum with 10% potassium hydroxide solution. Journal of Dermatological Treatment 2014;25(3):246‐8. [PUBMED: 22639976]CENTRAL

Cathcart 2009 {published data only}

Cathcart S, Coloe J, Morrell DS. Parental satisfaction, efficacy, and adverse events in 54 patients treated with cantharidin for molluscum contagiosum infection. Clinical Pediatrics 2009;48(2):161‐5. [PUBMED: 18936288]CENTRAL

Chatproedrai 2007 {published data only}

Chatproedrai S, Suwannakarn K, Wananukul S, Theamboonlers A, Poovorawan Y. Efficacy of pulsed dye laser (585 nm) in the treatment of molluscum contagiosum subtype 1. Southeast Asian Journal of Tropical Medicine & Public Health 2007;38(5):849‐54. [PUBMED: 18041301]CENTRAL

de Waard 1990 {published data only}

de Waard‐van der Spek FB, Oranje AP, Lillieborg S, Hop WC, Stolz E. Treatment of molluscum contagiosum using a lidocaine/prilocaine cream (EMLA) for analgesia. Journal of the American Academy of Dermatology 1990;23(4 Pt 1):685‐8. [PUBMED: 2229496]CENTRAL

He 2001 {published data only}

He H, Lu JY, Fang J, et al. Observation on effect of four kinds of therapy for molluscum contagiosum. Chinese Journal of Dermatovenereology 2001;15(5):308‐9. [CENTRAL: CN‐00454307]CENTRAL

Hengge 2000 {published data only}

Hengge UR, Esser S, Schultewolter T, Behrendt C, Meyer T, Stockfleth E, et al. Self‐administered topical 5% imiquimod for the treatment of common warts and molluscum contagiosum. British Journal of Dermatology 2000;143(5):1026‐31. [PUBMED: 11069514]CENTRAL

Holt 2011 {published data only}

Holt S, Webster‐Longin M, Perrin K, Baker T, Beasley R. The use of honey in the treatment of molluscum contagiosum in children. Presented at World Dermatology Congress, Seoul, Korea. May 2011. CENTRAL

Juhlin 1980 {published data only}

Juhlin L, Evers H, Broberg F. A lidocaine‐prilocaine cream for superficial skin surgery and painful lesions. Acta Dermato‐Venereologica 1980;60(6):544‐6. [PUBMED: 6162348]CENTRAL

Lim 2003 {published data only}

Lim DS, Egan CA. Insights into a novel treatment for molluscum. Acta Paediatrica 2003;92(2):265‐6. [PUBMED: 12710660]CENTRAL

Manchanda 1997a {published data only}

Manchanda RK, Mehan N, Bahl R, Atey R. Double blind placebo controlled clinical trials of homeopathic medicines in warts and molluscum contagiosum. Central Council for Research in Homeopathy Quarterly Bulletin 1997;19(3&4):25‐30. [CENTRAL: CN‐00478663]CENTRAL

Metkar 2008 {published data only}

Metkar A, Pande S, Khopkar U. An open, nonrandomized, comparative study of imiquimod 5% cream versus 10% potassium hydroxide solution in the treatment of molluscum contagiosum. Indian Journal of Dermatology, Venereology and Leprology 2008;74(6):614‐8. [PUBMED: 19171985]CENTRAL

Myhre 2008 {published data only}

Myhre PE, Levy ML, Eichenfield LF, Kolb VB, Fielder SL, Meng TC. Pharmacokinetics and safety of imiquimod 5% cream in the treatment of molluscum contagiosum in children. Pediatric Dermatology 2008;25(1):88‐95. [PUBMED: 18304162]CENTRAL

Puri 2009 {published data only}

Puri N. A study on the use of imiquimod for the treatment of genital molluscum contagiosum and genital warts in female patients. Indian Journal of Sexually Transmitted Diseases 2009;30(2):84‐8. [PUBMED: 21938126]CENTRAL

Rosdahl 1988 {published data only}

Rosdahl I, Edmar B, Gisslén H, Nordin P, Lillieborg S. Curettage of molluscum contagiosum in children: analgesia by topical application of lidocaine/prilocaine cream (EMLA). Acta Dermato‐Venereologica 1988;68(2):149‐53. [PUBMED: 2453995]CENTRAL

Sadick 2009 {published data only}

Sadick N, Sorhaindo L. A comparative split‐face study of cryosurgery and trichloroacetic acid 100% peels in the treatment of HIV‐associated disseminated facial molluscum contagiosum. Cutis 2009;83(6):299‐302. [PUBMED: 19681340]CENTRAL

Salmanpour 2006 {published data only}

Salmanpour R, Razmavar MR, Seyf I. Treatment of molluscum contagiosum with griseofulvin or cryotherapy. Iranian Journal of Dermatology 2006;9(1):5. [CENTRAL: CN‐00615975]CENTRAL

Schalka 2010 {published data only}

Schalka S, Addor FAS, Silva VDM, Pinto PC, Milan ALK, Pannuti EMB. A randomized, open‐label, comparative clinical study for the evaluation of safety, tolerability and analgesic efficacy of two different presentations of topical medication in the treatment of dermatological curettage of molluscum contagiosum in pediatric patients [Estudo clinico randomizado, aberto e comparativo para avaliacao de seguranca, tolerabilidade e eficacia analgesica de duas diferentes apresentacoes de medicamento topico na realizacao de curetagem dermatologica de molusco contagioso em pacientes pediatricos]. Revista Brasileira de Medicina 2010;67(6):201‐7. [CENTRAL: CN‐00803780]CENTRAL

Simonart 2008 {published data only}

Simonart T, De Maertelaer V. Curettage treatment for molluscum contagiosum: a follow‐up survey study. British Journal of Dermatology 2008;159(5):1144‐7. [PUBMED: 18795919]CENTRAL

Skinner 2000 {published data only}

Skinner RB, Ray S, Talanin NY. Treatment of molluscum contagiosum with topical 5% imiquimod cream. Pediatric Dermatology 2000;17(5):420. [PUBMED: 11085678]CENTRAL

Syed 1994 {published data only}

Syed TA, Lundin S, Ahmad M. Topical 0.3% and 0.5% podophyllotoxin cream for self‐treatment of molluscum contagiosum in males. A placebo‐controlled, double‐blind study. Dermatology 1994;189(1):65‐8. [CENTRAL: CN‐00102127; PUBMED: 8003791]CENTRAL

Syed 1998 {published data only}

Syed TA, Goswami J, Ahmadpour OA, Ahmad SA. Treatment of molluscum contagiosum in males with an analog of imiquimod 1% in cream: a placebo‐controlled, double‐blind study. Journal of Dermatology 1998;25(5):309‐13. [PUBMED: 9640884]CENTRAL

Weller 1999 {published data only}

Weller R, O'Callaghan CJ, MacSween RM, White MI. Scarring in molluscum contagiosum: comparison of physical expression and phenol ablation. BMJ 1999;319(7224):1540. [PUBMED: 10591712]CENTRAL

Yabut‐Catalasan 2003 {published data only}

Yabut‐Catalasan RO, Paliza AC. 10% Potassium Hydroxide as treatment for molluscum contagiosum: a double‐blind, placebo‐controlled study. Journal of the Philippine Dermatological Society 2003;12(1):28‐35. [CENTRAL: CN‐00602272]CENTRAL

Elzawahry 1964 {published data only}

El Zawahry M. Virus skin diseases: frequency and trial of antiviral agent. Journal of the Egyptian Medical Association 1963;46:1303‐14. [PUBMED: 14162107]CENTRAL

Köse 2013 {published data only}

Köse O, Özmen I, Arca E. An open, comparative study of 10% potassium hydroxide solution versus salicylic and lactic acid combination in the treatment of molluscum contagiosum in children. Journal of Dermatological Treatment 2013;24(4):300‐4. [PUBMED: 22214282]CENTRAL

Muzaffar 2014 {published data only}

Muzaffar F, Faiz F. Comparison of 5% potassium hydroxide with 10% potassium hydroxide solution in treatment of molluscum contagiosum: comparative study. Journal of Pakistan Association of Dermatologists 2014;24(4):337‐41. [www.jpad.org.pk/Oct%20Dec%202014/11.%20Original%20article%20KoH%20in%20molluscum%20contagiosum.pdf]CENTRAL

NCT01348386 {published data only}

NCT01348386. Efficacy and tolerance of potassium hydroxide (10% and 15%) in molluscum contagiosum (EKOH‐MOL 2008) [Efficacy and tolerance of the topical application of potassium hydroxide (10% and 15%) in the treatment of molluscum contagiosum]. clinicaltrials.gov/ct2/show/NCT01348386 Date first received: 4 May 2011. CENTRAL

NCT02665260 {unpublished data only}

NCT02665260. Safety and efficacy study of topical cantharidin for the treatment of molluscum contagiosum [Randomized pilot study investigating the safety and efficacy of topical cantharidin for the treatment of molluscum contagiosum]. clinicaltrials.gov/ct2/show/NCT02665260 Date first received: 31 December 2016. CENTRAL

Rajouria 2011 {published data only}

Rajouria EA, Amatya A, Karn D. Comparative study of 5% potassium hydroxide solution versus 0.05% tretinoin cream for Molluscum Contagiosum in children. Kathmandu University Medical Journal 2011;9(36):291‐4. [PUBMED: 22710541]CENTRAL

Tanissa 1951 {published data only}

Tanissa A. 62 cases of molluscum contagiosum in a boarding‐school; trial therapy with sulfonamides, podophyllin and aureomycin [Sessenta e dois casos de "molluscum contagiosum" em um internato. Ensaios teraputicos pelas sulfonamidas, podofilina e aureomicina]. Gazeta Médica Portuguesa 1951;4(1):77‐83. [ref 44 of Cochrane Skin Group search 2014; PUBMED: 14823272]CENTRAL

Unknown Chinese author 1991 {published data only}

Unknown Chinese author(s). Different concentrations of iodine tincture in the treatment of molluscum contagiosum. Chinese Journal of Dermatology 1991;24(6):405. [ref 1 of Cochrane Skin Group search 2014]CENTRAL

NCT02024581 {published data only}

NCT02024581. A dose range‐finding phase 2 trial of a botanical drug for the treatment of molluscum contagiosum in pediatric subjects [A single‐center, double‐blind, placebo‐controlled, randomized safety and efficacy trial of a botanical drug product, East Indian Sandalwood Oil (EISO), at one dose level for the treatment of molluscum contagiosum in pediatric subjects]. clinicaltrials.gov/ct2/show/NCT02024581 Date first received: 19 December 2013. CENTRAL

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Katz 2013

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Wishart J. The local treatment of psoriasis and molluscum contagiosum. Lancet 1903;161(4154):1030‐1.

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Yasher SS, Shamiri B. Oral cimetidine treatment of molluscum contagiosum. Pediatric Dermatology 1999;16(6):493. [PUBMED: 10651572]

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Al‐Mutairi 2010

Methods

Randomised controlled trial

Participants

74 children 2 to 12 years of age, hospital outpatient clinic in Kuwait

Interventions

Imiquimod 5% for up to 16 weeks versus cryospray for up to 2 weeks

Outcomes

Cure at 3, 6, 12, and 16 weeks; cosmetic outcome; adverse effects

Notes

Funding: not mentioned

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No details except 'randomly assigned'

Allocation concealment (selection bias)

Unclear risk

No details

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Probably not blinded: cream versus cryospray

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Probably not blinded: cream versus cryospray

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

All participants had complete follow‐up.

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Low risk

All participants had complete follow‐up.

Selective reporting (reporting bias)

Unclear risk

Protocol not available

Other bias

Unclear risk

No baseline imbalance for gender, MC area, morphology, MC location, or baseline lesion count, but no data on compliance

Antony 2001

Methods

Double‐blind randomised placebo‐controlled trial

Participants

38 patients (1 to 16 years; M/F: 18/20) were enrolled, Dept of Dermatology, UK.

Interventions

35 mg/kg/day cimetidine, given once daily as oral suspension versus a matching placebo for 3 months

Outcomes

Complete clearance after 4 months of treatment. Reduction of lesions. Adverse events: not mentioned

Notes

50% dropout rate. Published abstract only. Funding: not mentioned

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: "Randomized". No details in abstract

Allocation concealment (selection bias)

Unclear risk

Method of concealment is not described in the abstract.

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "Double‐blind placebo‐controlled"; "The dose of cimetidine was 35 mg/kg‐1/day‐1"; "The placebo group received a manufactured placebo". Probably done, placebo controlled, both suspensions

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "Double‐blind placebo‐controlled"; "The dose of cimetidine was 35 mg/kg‐1/day‐1"; "The placebo group received a manufactured placebo". Probably done, placebo controlled, both suspensions

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Unclear risk

Not reported in the abstract

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

High risk

4 months: 19/35 completed the treatment course. Quote: "The number of patients who received placebo or cimetidine was similar in the groups that did not attend or withdrew." > 30% withdrawals

Selective reporting (reporting bias)

Unclear risk

Unclear

Other bias

Unclear risk

Quote: "The mean age and sex of the patients and incidence of atopic disease in each treatment group was similar." No compliance data

Bazza 2007

Methods

Randomised controlled trial. Body sides were randomised left‐right.

Participants

30 children (2 to 12 years of age; M/F: 18/12) were recruited, Dept of Dermatology, UK.

Interventions

Sterile normal 0.9% saline versus 5% potassium hydroxide for 3 weeks

Outcomes

Complete clearance of lesions and side effects after 12 weeks

Notes

Unpublished, year of study unclear. Unpublished paper obtained in 2007. Funding: not mentioned

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: "Where treatment with 0.9% NS and 5% KOH solution was randomised to right or left side of body". Insufficient information

Allocation concealment (selection bias)

Unclear risk

Quote: "Where treatment with 0.9% NS and 5% KOH solution was randomised to right or left side of body". Insufficient information

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "30 patients were recruited in this double‐blind study". "All subjects were given seven bottles clearly labelled R and seven bottles labelled L, for use on the right and left side of the body respectively (patient and investigator did not know which is active site)"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "30 patients were recruited in this double‐blind study". "All subjects were given seven bottles clearly labelled R and seven bottles labelled L, for use on the right and left side of the body respectively (patient and investigator did not know which is active site)"

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

High risk

12 weeks: 10/30 did not complete study, 2 withdrew due to severe stinging from KOH, and 8 children were lost to follow‐up. > 30% dropouts

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No medium‐ or long‐term follow‐up

Selective reporting (reporting bias)

Unclear risk

Unclear

Other bias

Unclear risk

No baseline comparison. No compliance data

Burke 2004

Methods

Randomised controlled trial

Participants

31 children, mean age 4.6 years. Sex not reported. USA, outpatient clinic

Interventions

10% lemon myrtle oil or vehicle (olive oil) for 3 weeks

Outcomes

Complete clearance or > 90% reduction in number of lesions after 3 weeks

Notes

Funding: Center for Biomedical Research, a commercial institute involved in drug research and sale. Partner of Naturopathix (ZymaDerm for molluscum)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "Children were randomised to active treatment or vehicle (virgin olive oil) by blindly choosing a token numbered from 1 to 100. Odd numbers were assigned to active treatment even numbers to vehicle"

Allocation concealment (selection bias)

Low risk

Quote: "Children were randomised to active treatment or vehicle (virgin olive oil) by blindly choosing a token numbered from 1 to 100."  "Parents and physicians were blinded to treatment protocol. A treatment key was held by a participating pharmacist (no patient contact) until study completion"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "Parents and physicians were blinded to treatment protocol. A treatment key was held by a participating pharmacist (no patient contact) until study completion." "A mild synthetic lemon fragrance not containing citral was added to scent the control olive oil preparation. This fragrance by itself had no therapeutic effect." Vehicle controlled.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "Parents and physicians were blinded to treatment protocol. A treatment key was held by a participating pharmacist (no patient contact) until study completion." "A mild synthetic lemon fragrance not containing citral was added to scent the control olive oil preparation. This fragrance by itself had no therapeutic effect." Vehicle controlled.

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

21 days: 4/31 withdrew: 1/16 in lemon myrtle oil group lost to follow‐up; 3/15 missing in vehicle group, withdrew because of worsening of the molluscum. Withdrawn participants included in analysis as failures.

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

The study did not address medium‐ and long‐term outcomes.

Selective reporting (reporting bias)

Unclear risk

Unclear

Other bias

Unclear risk

The mean number of lesions at enrolment did not differ between treatment groups. No sex or age comparison between groups. No compliance data

Chathra 2015

Methods

Randomised trial

Participants

Children 1 to 18 years with a minimum of 3 molluscum lesions, target sample size 40, Karnataka, India

Interventions

Imiquimod 5% cream application alternate nights versus 10% potassium hydroxide solution applied alternate nights for 12 weeks

Outcomes

Complete clearance, time points 4, 8, and 12 weeks

Notes

Funding: this study reported that they had no support.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

"The lottery method"; no details

Allocation concealment (selection bias)

Unclear risk

No details

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Different instructions, therefore not blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Different instructions, therefore not blinded

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

No loss to follow‐up

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No medium‐ and long‐term outcomes

Selective reporting (reporting bias)

Unclear risk

No protocol available

Other bias

Unclear risk

No baseline imbalance in terms of age, gender, and number of lesions. No compliance data

Coloe Dosal 2014

Methods

Randomised controlled trial

Participants

32 children, 5 to 10 years of age, recruited in local paediatricians' offices, university clinics and through mass emails to university students and staff, North Carolina, USA

Interventions

Cantharidin collodion 0.7% versus vehicle collodion for approximately 8 weeks

Outcomes

Complete clearance, lesion counts, adverse effects, approximately 8 weeks after start of treatment

Notes

Funding: Doris Duke Charitable Foundation

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"Randomization schedule was prepared before first recruitment using permuted blocks of size 2"

Allocation concealment (selection bias)

Low risk

After eligibility was assessed, study personnel "assigned the next unique subject identification number and dispensed the appropriate drug"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

"Patients, parents and investigators were blinded to treatment assignment" and "placebo was identical in texture and smell"

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

"Patients, parents and investigators were blinded to treatment assignment" and "placebo was identical in texture and smell"

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

2 participants dropped out immediately after randomisation because they did not meet all eligibility criteria (< 20%).

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No long‐term data

Selective reporting (reporting bias)

Low risk

Reported outcomes similar to those in trial register resume.

Other bias

Unclear risk

Imbalance in dry skin. Allocation bias was due to dropout.

Eichenfield 2005

Methods

Randomised controlled trial

Participants

323 children, 2 to 12 years of age, with molluscum contagiosum in 19 outpatient clinics in the USA were randomised.

Interventions

Imiquimod cream 5% vs vehicle cream 3 times weekly for 16 weeks

Outcomes

Lesion clearance, lesion counts, time to complete clearance, side effects after 4, 8, 12, 16, 18, and 28 weeks

Notes

Funding by pharmaceutical company (3M), unpublished

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"Subjects were randomly assigned to a treatment arm in blocks of 6 according to a computer‐generated randomizations schedule. Randomization was 2:1 (active:vehicle) for a planned number of 300 subjects to be randomised into the study" (p.40)

Allocation concealment (selection bias)

Low risk

"The treatment assignments were concealed from the subjects, investigators and study staff, and the 3M clinical research team. The clinical packaging group at 3M Pharmaceuticals held the master code for the treatment randomizations schedule, and supplied the investigators with each subject’s treatment assignment as a hidden (tear‐off) panel on the study cream label, which was affixed to the blinded Drug Label page" (p.43)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

See allocation concealment.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

See allocation concealment.

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Unclear risk

Unclear when participants dropped out, so impossible to distinguish short‐term from long‐term. Primary analysis by intention‐to‐treat

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Low risk

53/323 participants dropped out, reasons mentioned (< 30%).

Selective reporting (reporting bias)

Low risk

All outcomes seem to have been reported.

Other bias

Low risk

No baseline imbalance, compliance data available, primary analysis by intention‐to‐treat

Handjani 2014

Methods

Open randomised trial

Participants

30 people with molluscum contagiosum in Iran

Interventions

10% potassium hydroxide solution versus cryotherapy

Outcomes

Lesion response and side effects 4 weeks after start of treatment

Notes

Funding: not mentioned

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

"the simple randomization method"; no details

Allocation concealment (selection bias)

Unclear risk

No details

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Different administration, so could not be blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Different administration, so could not be blinded

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

No loss to follow‐up

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

Not applicable, no medium‐ and long‐term outcomes

Selective reporting (reporting bias)

Unclear risk

No protocol available

Other bias

Unclear risk

No baseline comparison; no compliance data

Hanna 2006

Methods

Randomised controlled trial

Participants

124 children, 1 to 16 years of age, dermatology clinic, Montreal, Canada

M/F: 57/67

Interventions

4 arms: curettage, topical cantharidin 0.7%, topical salicylic acid 16.7% + lactic acid 16.7%, topical imiquimod cream 5%

Outcomes

Number of visits required. Intervals between study visits not reported, so outcome data not suitable for inclusion.

Notes

Total number of participants unclear. Percentage of group 3 in Table 1 does not correspond to number mentioned in text.

Funding: 3 pharmaceutical companies provided treatments for free.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "The randomizations list was generated by specialized computer software (PC‐PLAN, Dalal, 1996)"

Allocation concealment (selection bias)

Unclear risk

Quote: "The randomizations list was generated by specialized computer software (PC‐PLAN, Dalal, 1996)." Insufficient information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Quote: "This is not a double‐blind study." Physical versus topical treatment

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Quote: "This is not a double‐blind study." Physical versus topical treatment

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Unclear risk

Not reported

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

Not reported

Selective reporting (reporting bias)

Unclear risk

Unclear

Other bias

Unclear risk

No baseline comparison. No compliance data

Leslie 2005

Methods

Randomised controlled trial

Participants

114 children, 1 to 15 years of age, sex not reported, UK, outpatient departments of teaching hospital and district general hospital

Interventions

Topical salicylic acid 12%, or phenol 10% + 70% alcohol, or 70% alcohol at monthly visits for a maximum of 6 months

Outcomes

Complete clearance of lesions after 6 months

Notes

Funding: pharmaceutical company provided medication

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "The participants were randomised according to a random number table"

Allocation concealment (selection bias)

High risk

Quote: "The investigators were not blinded to randomizations"

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Quote: "The patients in the salicylic acid groups were aware of their treatments. The other two groups treated with vehicle or phenol were single‐blinded, as the patients/parents were unaware of which treatment they received." "The vehicle and diluted phenol were prepared by the hospital pharmacy and labelled with a letter." "The investigators were not blinded for the randomization"

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Quote: "The patients in the salicylic acid groups were aware of their treatments. The other two groups treated with vehicle or phenol were single‐blinded, as the patients/parents were unaware of which treatment they received." "The vehicle and diluted phenol were prepared by the hospital pharmacy and labelled with a letter." "The investigators were not blinded for the randomization"

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Unclear risk

No short‐term outcomes reported.

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

High risk

Up to 6 months: 31/114 lost to follow‐up: 13/37 in salicylic acid arm, 9/41 in dilute phenol arm, 9/36 in alcohol arm. > 30% dropouts 

Selective reporting (reporting bias)

Unclear risk

Unclear

Other bias

Unclear risk

Quote: "The baseline characteristics of the three groups were similar." See also Table I, Baseline characteristics. No compliance data

Machado 2010

Methods

Randomised controlled trial

Participants

50 children, 3 to 15 years of age, recruited in a hospital outpatient clinic in Brazil

Interventions

(1) potassium hydroxide 10% in aqueous solution; (2) 14% salicylic acid + 14% lactic acid in collodion; both for 3 months or (3) curettage once

Outcomes

Cure, adverse effects 90 days after start of treatment

Notes

2 groups applied medication at home; treatment duration was not reported for these groups. These participants were seen every 15 days until day 90 after start of treatment. The third group underwent curettage (once). These participants were seen day 7 and 90 after treatment. Outcomes were reported at 90 days, but as we do not know how long topical treatments were applied and assuming that parents were instructed to stop treatment when lesions had resolved, it is hard to say whether these are short‐ or long‐term outcomes (apart from the curettage group).

Funding: 2 pharmaceutical companies provided medication.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

“Patients were allocated randomly into three study groups”; insufficient information

Allocation concealment (selection bias)

Unclear risk

No details

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Different treatments: topical treatment versus curettage

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Different treatments: topical treatment versus curettage. Also, follow‐up moments differed between treatment groups (topical: every 15 days for 90 days; curettage: days 7 and 90 after the procedure)

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Unclear risk

Proportions in table and text show that these were not based on number of participants randomised, so there must have been loss to follow‐up; magnitude unclear.

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No medium‐ or long‐term follow‐up

Selective reporting (reporting bias)

Unclear risk

No protocol

Other bias

Unclear risk

No baseline comparison. Imbalance in treatment adherence (not statistically significant)

Manchanda 1997b

Methods

Double‐blind randomised controlled trial, addressing various types of warts (n = 124), including molluscum contagiosum (n = 20)

Participants

14 molluscum patients (sex distribution unknown) randomised to the treatment arm, 6 patients were randomised to receive plain sugar globules as a placebo (personal communication Dr Manchanda). 10 participants were aged below 10 years; 7 from 10 to 20 years; and 3 from 21 to 30 years (personal communication with Dr Manchanda). India, Homoeopathic Medical College & Hospital, New Delhi

Interventions

Different potencies of homeopathic drug calcarea carbonica daily for 15 days (n = 14) versus sugar globules (placebo). Unclear which participants received what potency

Outcomes

Improvement (not clear after what period)

Notes

Paper reports on (1) cross‐over study and (2) parallel study. We excluded the cross‐over study because 1 arm had fewer than 5 participants.

Funding: not mentioned

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: "In this research design, each case was initially given a drug code in 30 potency which could be either active drug or placebo." Randomisation not mentioned in paper, "sequence was generated manually" (personal communication)

Allocation concealment (selection bias)

Unclear risk

Quote: "In this research design, each case was initially given a drug code in 30 potency which could be either active drug or placebo." "Therefore it was found that after decoding method of concealment is not described"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "Two types of placebo controlled double‐blind clinical trials were undertaken." "The subjects were given both drug and placebo." Quote (personal communication): “The identity of the drugs was kept secret in a sealed cover which was opened only at the time un‐blinding the experiment." "The plain sugar globules looks like homoeopathic drug Calcerea carbonica was used as placebo."

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "Two types of placebo controlled double‐blind clinical trials were undertaken." "The subjects were given both drug and placebo." Quote (personal communication): “The identity of the drugs was kept secret in a sealed cover which was opened only at the time un‐blinding the experiment." "The plain sugar globules looks like homoeopathic drug Calcerea carbonica was used as placebo."

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

15 days: 20/124 dropouts, unclear what skin disease and group assignment

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No long‐term outcome

Selective reporting (reporting bias)

Unclear risk

Unclear

Other bias

Unclear risk

No baseline comparison. No compliance data

Markum 2012

Methods

Randomised controlled trial

Participants

53 children (aged 9 months to 15 years according to trial register), recruited in outpatient clinic in Idaho, USA

Interventions

(1) iodine; (2) tea tree oil (Melaleuca alternifolia); (3) tea tree oil + iodine for 30 days

Outcomes

Cure or reduction in the number of lesions > 90%, adverse effects, 30 days after start of treatment

Notes

Funding: Center for Biomedical Research, a commercial institute involved in drug research and sale. Partner of Naturopathix (ZymaDerm for molluscum)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

According to trial register: "Subject or subject's parent blindly chose a numbered token from an opaque container containing tokens numbered 1‐99. Numbers 1‐33 assigned to iodine treatment, numbers 34‐66 assigned to tea tree oil treatment, numbers 67‐99 assigned to tea tree oil + iodine treatment" and "Randomization by sealed container"

Allocation concealment (selection bias)

Low risk

According to trial register: "Subject or subject's parent blindly chose a numbered token from an opaque container containing tokens numbered 1‐99. Numbers 1‐33 assigned to iodine treatment, numbers 34‐66 assigned to tea tree oil treatment, numbers 67‐99 assigned to tea tree oil + iodine treatment"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: “Patients and physicians were blinded to treatment protocol.” “A mild synthetic lemon fragrance not containing citral was added to scent the iodine olive oil preparation.”

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: “Patients and physicians were blinded to treatment protocol.” “A mild synthetic lemon fragrance not containing citral was added to scent the iodine olive oil preparation.”

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

5/53 participants (less than 20%) were lost to follow‐up (Markum 2012, from Table 1 of publication).

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No long‐term data

Selective reporting (reporting bias)

Low risk

Reported outcomes similar to those mentioned in trial register

Other bias

Unclear risk

No baseline comparison. No compliance data

Ohkuma 1990

Methods

Randomised controlled trial (written correspondence Dr Ohkuma), the method of generation of randomisation sequence remained unclear, as was the concealment of allocation. It was also unclear if participants were analysed according to the group to which they were randomised (intention‐to‐treat analysis) and how blinding was performed.

Participants

35 patients with molluscum contagiosum, aged between 2 and 9 years (M/F: 21/14), Japan, Department of Dermatology

Interventions

3 interventions were compared: 10% povidone iodine solution combined with 50% salicylic acid plaster (n = 20), iodine alone (n = 5), and salicylic plaster alone (n = 10).

Outcomes

Time to cure. Study duration unknown, but paper indicated that treatment continued as long as necessary; range was 7 to 64 days; mean 26 days for iodine + plaster, 86 days for iodine only, and 47 days for plaster only .

Notes

No baseline comparison, no compliance data

Funding: not mentioned

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomised (personal communication, not in paper). Insufficient information about the sequence generation

Allocation concealment (selection bias)

Unclear risk

Insufficient information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Iodine versus salicylic plaster: hard to mask

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Iodine versus salicylic plaster: hard to mask

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

No loss reported, all participants in outcome table. Follow‐up period unclear. Duration of treatment ranged from 7 to 64 days.

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No medium‐ or long‐term follow‐up

Selective reporting (reporting bias)

Unclear risk

Unclear

Other bias

Unclear risk

Quote: "In the former, two girls and three boys between the age of 3 and 5 were included and 4 girls and 6 boys between 2 and 9 comprised the latter control group." No imbalance for sex. No compliance data

Ormerod 1999

Methods

Group sequential double‐blind randomised trial

Participants

30 molluscum patients were enrolled, 16 in the acidified nitrite group and 14 controls, with a median age of 6 years, 22 girls and 8 boys. UK, Department of Dermatology

Interventions

5% sodium nitrite co‐applied daily with 5% salicylic acid under occlusion versus identical cream with 5% salicylic acid omitting sodium nitrite, for 3 months

Outcomes

Time to complete resolution, adverse events, study duration 3 months

Notes

No baseline imbalance for duration and number of lesions, no compliance data.

Funding: not mentioned

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: "Group sequential design in which subjects were randomised to receive either"; insufficient information about the sequence generation

Allocation concealment (selection bias)

Unclear risk

Method of concealment not described.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Quote: "Double‐blind, group sequential design in which subjects were randomised to receive either 5% sodium nitrite co‐applied with 5% salicylic acid under occlusion, or identical cream with 5% salicylic acid but omitting sodium nitrite, as a control." Not done, active intervention was associated with brown staining.

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Quote: "Double‐blind, group sequential design in which subjects were randomised to receive either 5% sodium nitrite co‐applied with 5% salicylic acid under occlusion, or identical cream with 5% salicylic acid but omitting sodium nitrite, as a control." Not done, active intervention was associated with brown staining.

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Unclear risk

Only long‐term data

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

High risk

21/30 dropouts after 3 months (> 30%)

Selective reporting (reporting bias)

Unclear risk

Unclear

Other bias

Unclear risk

No compliance data. Duration and number of lesions were very similar (communication with author).

Paller 2005a

Methods

Randomised controlled trial

Participants

125 children, 1 to 12 years of age, with molluscum contagiosum in 9 outpatient clinics in the USA and Canada were randomised.

Interventions

Imiquimod cream 5% vs vehicle cream daily for 8 weeks

Outcomes

Lesion clearance, lesion counts, time to complete clearance, side effects, 12 weeks after start of treatment

Notes

Funding by pharmaceutical company (3M), unpublished

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

“Subjects were randomly assigned to a treatment arm in blocks of 4 according to a computer‐generated randomizations.” (p.32)

Allocation concealment (selection bias)

Low risk

“Subjects/legal parental custodian(s) and investigators were unaware of the study assignment” (p.25)

"This was a double‐blind, vehicle‐controlled study. 3M held the master code for the treatment randomizations schedule and supplied the investigators with each subject’s randomizations code as a hidden (tear‐off) disclosure panel on the study cream carton label. The randomizations code for an individual subject was to be broken only in case of an emergency, such as a serious adverse event (SAE)." (p.34)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

See allocation concealment.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

See allocation concealment.

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

Not applicable: primary analysis by intention‐to‐treat

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No long‐term outcomes

Selective reporting (reporting bias)

Low risk

All outcomes seem to have been reported.

Other bias

Low risk

No baseline imbalance, compliance data available, primary analysis by intention‐to‐treat

Paller 2005b

Methods

Randomised controlled trial

Participants

379 children, 2 to 12 years of age, with molluscum contagiosum in 19 outpatient clinics in the USA were randomised.

Interventions

Imiquimod cream 5% vs vehicle cream 3 times weekly for 16 weeks

Outcomes

Lesion clearance, lesion counts, time to complete clearance, side effects, 4, 8, 12, 16, 18, and 28 weeks after start of treatment

Notes

Funding by pharmaceutical company (3M), unpublished

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"Subjects were randomly assigned to a treatment arm in blocks of 6 according to a computer‐generated randomizations schedule. Randomization was 2:1 (active:vehicle)" (p.40)

Allocation concealment (selection bias)

Low risk

"This was a double‐blind, vehicle‐controlled study; accordingly, the treatment assignments were concealed from the subjects, investigators and study staff, and the 3M clinical research team. The clinical packaging group at 3M Pharmaceuticals held the master code for the treatment randomizations schedule, and supplied the investigators with each subject’s treatment assignment as a hidden (tear‐off) panel on the study cream label, which was affixed to the blinded Drug Label page" (p.43)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

See allocation concealment.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

See allocation concealment.

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

Primary analysis by intention‐to‐treat

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Low risk

48/379 discontinued, reasons were mentioned (< 30%).

Selective reporting (reporting bias)

Low risk

All outcomes seem to have been reported.

Other bias

Low risk

No baseline imbalances, reported on compliance, primary analysis by intention‐to‐treat

Saryazdi 2004

Methods

Randomised trial

Participants

30 children, age and sex unknown, Iran, hospital dermatology clinic

Interventions

Topical benzoyl peroxide 10% cream versus tretinoin 0.05% cream, 2 times daily for 4 weeks

Outcomes

Lesion count, lesion free, and side effects, 6 weeks after start of treatment

Notes

Information based on abstract; proportions cured used to estimate absolute numbers. Abstract published in 2004; unclear when study was carried out.

Funding: not mentioned

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not reported

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

"Investigator masked"; no further details

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

"Investigator masked"; no further details

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Unclear risk

Not reported

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No medium‐ or long‐term follow‐up

Selective reporting (reporting bias)

Unclear risk

Efficacy was assessed at 2, 4, and 6 weeks, but the paper only reports results at week 6.

Other bias

Unclear risk

No baseline characteristics or compliance data

Seo 2010

Methods

Randomised controlled trial

Participants

30 patients, 1 to 36 years of age, setting unclear, Korea

Interventions

Imiquimod cream 5% versus potassium hydroxide solution 10% "for 3 months" (see Notes)

Outcomes

Cure, adverse effects

Notes

Applied medication until all lesions were cleared. Mean duration of treatment > 4 months; this is inconsistent with 'time after treatment'.

Funding: not mentioned

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information

Allocation concealment (selection bias)

Unclear risk

Insufficient information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Open study, method of application differed between treatment arms.

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Open study, so investigators were aware of treatment assignment.

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

3 participants lost to follow‐up (< 20%)

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Low risk

3 participants lost to follow‐up (< 30%)

Selective reporting (reporting bias)

Unclear risk

No protocol available

Other bias

Unclear risk

Imbalance in sex. No compliance data

Short 2006

Methods

Double‐blind, randomised, placebo‐controlled trial

Participants

20 children from a paediatric dermatology clinic, age range 2 to 12 years, M/F 6/14. UK, Department of Dermatology, London

Interventions

Application of 10% potassium hydroxide solution twice daily applied with a cotton swab, continued until the lesions showed signs of inflammation (n = 10). The control group received saline (n = 10), for a maximum of 3 months.

Outcomes

Time to resolution, adverse events 3 months after start of treatment

Notes

Number of participants who completed the study differs between unpublished paper (18/20) and published paper (19/20). Latter number included in corrected version of 2009 update (December 2009).

Funding: not mentioned

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: "The children were randomly allocated by the dispensing pharmacist to receive one of two treatments". Insufficient information

Allocation concealment (selection bias)

Low risk

Quote: "The children were randomly allocated by the dispensing pharmacist to receive one of two treatments." Central allocation: pharmacy controlled

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "Both the patients and the observer were blinded". "Both solutions were dispensed in identical, unlabeled bottles. The sequence was not revealed until the end of the study." Staining and stinging reported in the potassium hydroxide group. Participant, care provider, and outcome assessor probably blinded.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "Both the patients and the observer were blinded". "Both solutions were dispensed in identical, unlabeled bottles. The sequence was not revealed until the end of the study." Staining and stinging reported in the potassium hydroxide group. Participant, care provider, and outcome assessor probably blinded.

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

2 weeks: 1/20 did not complete study. 1/10 in the potassium hydroxide group withdrew after 2 weeks because of discomfort of the skin localised to the application site.

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Low risk

Not applicable: no long‐term results

Selective reporting (reporting bias)

Unclear risk

Unclear

Other bias

Unclear risk

No baseline imbalance for sex, lesion site, and numbers. No compliance data

Theos 2004

Methods

Randomised controlled trial

Participants

23 children, 1 to 9 years of age, M/F 12/11, USA, Alabama, Illinois, New York

Interventions

Imiquimod cream 5% or vehicle 3 times a week for 12 weeks

Outcomes

Complete or partial clearance (> 30% decrease from baseline lesion count), adverse events after 4, 8, and 12 weeks

Notes

Presented as a pilot study. Funding: not mentioned, but 1 of the authors was reported to be a consultant for 3M Pharmaceuticals, and was also the principal investigator of 2 other unpublished studies funded by this company (Paller 2005a; Paller 2005b).

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: "Eligible patients were randomised to either imiquimod or vehicle". Insufficient information

Allocation concealment (selection bias)

Unclear risk

Quote: "Eligible patients were randomised to either imiquimod or vehicle". Insufficient information

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Quote: "In a Double Blind, Randomized Pilot Trial"; "imiquimod vs vehicle". Only participants and physicians involved, so probably at low risk of bias.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Quote: "In a Double Blind, Randomized Pilot Trial"; "imiquimod vs vehicle". Only participants and physicians involved, so probably at low risk of bias.

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

2 weeks: 2/23 did not complete the study (discontinued treatment)

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No medium‐ or long‐term follow‐up

Selective reporting (reporting bias)

Unclear risk

Unclear

Other bias

Unclear risk

Baseline imbalance for mean lesion count, imiquimod: 27.0 versus vehicle: 19.4 (not statistically significant). No compliance data

Uçmak 2013

Methods

Randomised controlled trial

Participants

29 children, 15 months to 18 years of age, outpatient clinic, Turkey

Interventions

Potassium hydroxide 2.5% versus potassium hydroxide 5% twice daily for 60 days

Outcomes

Cure, adverse effects after 15, 30, 45, and 60 days

Notes

Funding: not mentioned, but authors report having no conflicts of interest.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No details except "randomised study"

Allocation concealment (selection bias)

Unclear risk

No details

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

"The solution vials were indistinguishable, regardless of content, and were stored at room temperature.” But paper does not use the word 'blinded'.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Unclear whether outcome assessors were aware of treatment assignment

Incomplete outcome data (attrition bias)
Short‐term outcomes (up to 3 months)

Low risk

1 participant in potassium hydroxide 2.5% group and 2 participants in potassium hydroxide 5% group "removed from study" due to irregular attendance at follow‐up visits. 1 further participant in potassium hydroxide 5% group quit study due to excessive burning. Total number of loss to follow‐up: 4/29 (< 20%)

Incomplete outcome data (attrition bias)
Medium‐ and long‐term outcomes (3‐6 months and longer)

Unclear risk

No long‐term outcomes

Selective reporting (reporting bias)

Unclear risk

No protocol

Other bias

Unclear risk

No baseline comparison, no compliance data

KOH: potassium hydroxide
MC: molluscum contagiosum
NS: normal saline

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Arican 2006

Open‐label study, imiquimod 5% cream (n = 12)

Barton 2002

HIV‐infected patients (n = 40)

Bayerl 2003

Open‐label study, imiquimod 5% cream (n = 13)

Caballero 1996

RCT comparing 2 types of cryotherapy for cutaneous skin lesions; 124 participants, of which 10 were molluscum patients, distributed 9:1 over 2 arms

Can 2014

Patient series, 10% potassium hydroxide (n = 40)

Cathcart 2009

Patient series, topical cantharidin (n = 54)

Chatproedrai 2007

Pulsed dye laser (n = 20), not randomised (personal communication)

de Waard 1990

Study on analgesic effect of lidocaine/prilocaine (EMLA) cream before physical therapy. Not a focus of this review (n = 83)

He 2001

Large parallel controlled study (n = 1656), with 4 arms, no randomisation (personal communication with Dr He through Taixiang Wu)

Hengge 2000

Open‐label study, imiquimod 5% cream, no control group, patients with common warts or molluscum contagiosum (n = 65)

Holt 2011

Patient series, topical treatment with Manuka honey (n = 15)

Juhlin 1980

Study on analgesic effect of lidocaine/prilocaine (EMLA) cream before physical therapy. Not a focus of this review (n = 24)

Lim 2003

Patient series of topical 5% imiquimod (n = 4)

Manchanda 1997a

Cross‐over study of patients with different types of warts (n = 43), 10 molluscum patients. 1 of the treatment arms (placebo first?) had fewer than 2 participants.

Metkar 2008

Non‐randomised, comparative study of imiquimod 5% cream versus 10% potassium hydroxide (n = 40)

Myhre 2008

Open‐label study, imiquimod 5% cream, no control group (n = 22)

Puri 2009

RCT of people with sexually transmitted disease, not a focus of this review

Rosdahl 1988

Study on analgesic effect of lidocaine/prilocaine (EMLA) cream before physical therapy. Not a focus of this review (n = 55)

Sadick 2009

Randomised split‐face study in 20 patients with disseminated facial molluscum contagiosum and HIV infection, not a focus of this review

Salmanpour 2006

Not randomised but alternate assignment (personal communication, Alireza Firooz)

Schalka 2010

RCT comparing two topical analgesics before curettage (n = 40). Not a focus of this review

Simonart 2008

Not a randomised trial, curettage (n = 73)

Skinner 2000

Case report, 3 children, topical imiquimod 5%

Syed 1994

RCT, n = 150, mainly genital lesions, not a focus of this review

Syed 1998

RCT, n = 100, mainly genital lesions, not a focus of this review

Weller 1999

Controlled trial (n = 16) comparing phenol ablation and physical expression. Lesions were unit of treatment and analysis. No randomisation

Yabut‐Catalasan 2003

Controlled trial (n = 34) of children aged 2 to 12 years. 10% potassium hydroxide versus placebo. Not randomised, but alternate assignment

RCT: randomised controlled trial

Characteristics of studies awaiting assessment [ordered by study ID]

Elzawahry 1964

Methods

Unknown, no full‐text paper and no abstract

Participants

Interventions

Outcomes

Notes

Köse 2013

Methods

Randomised trial

Participants

Patients with molluscum contagiosum in Turkey

Interventions

10% potassium hydroxide solution versus salicylic and lactic acid combination

Outcomes

Lesion response and side effects

Notes

Full text obtained August 2016. Email contact about unclear randomisations ("Patients were randomised into two treatment groups according to appealing number." "The treatment groups were not matched with the baseline characteristics because of the randomizations by application rank." (p.301) (8 August 2016)

Muzaffar 2014

Methods

Possibly randomised (participants were divided into 2 groups)

Participants

Children aged 2 to 14 years with molluscum contagiosum in Pakistan

Interventions

5% or 10% potassium hydroxide solution

Outcomes

Complete clearance, partial clearance, adverse effects

Notes

Summer 2016: asked author for additional information regarding randomisation (unclear from paper)

NCT01348386

Methods

Double‐blind, randomised clinical trial, in 3 groups

Participants

Children aged 2 to 6 years with molluscum contagiosum in Spain. Planned number of participants: 60

Interventions

Application of topical 10% potassium hydroxide in an aqueous solution; 15% potassium hydroxide; placebo

Outcomes

Primary outcome: efficacy (disappearance of lesions) after 60 days

Notes

Email correspondence in January 2015: results are expected soon

NCT02665260

Methods

From trial register:

Allocation: Randomized

Endpoint Classification: Safety/Efficacy Study

Intervention Model: Crossover Assignment

Masking: Double Blind (Subject, Caregiver, Investigator)

Primary Purpose: Treatment

Participants

n=100

Inclusion criteria:

  • 2 to 17 years of age

  • Healthy

  • < 50 molluscum contagiosum lesions

Exclusion criteria:

  • Immunosuppressed

  • Oral corticosteroids

  • Sexually active/pregnant

Interventions

Cantharidin 0.7% topical, cantharidin 0.7% topical with occlusion, placebo, or placebo with occlusion. Treatments were applied at weeks 0 and 3 (blinded phase). At week 6, all participants were treated with open‐label, topical cantharidin 0.7% without occlusion every 3 weeks until all lesions resolved (open‐label phase).

Outcomes

Primary outcome measures: Percentage of participants who achieve complete clearance at 6 weeks and 33 weeks [Time Frame: 33 weeks] [Designated as safety issue: No] Assess percentage of participants who achieve a lesion count of zero at 6 weeks (end of blinded phase) and 33 weeks (end of open‐label phase)
Secondary outcome measures: Frequency of adverse events [Time Frame: 33 weeks] [Designated as safety issue: No] Assessed by patient‐reported outcomes questionnaire at each visit

Notes

Study completion date: January 2016

Rajouria 2011

Methods

Randomised (abstract) or non‐randomised (methods) controlled clinical trial

Participants

Children with molluscum contagiosum in tertiary care centre in Nepal

Interventions

5% potassium hydroxide solution versus 0.05% tretinoin cream

Outcomes

Number of lesions, local and systemic side effects

Notes

February 2015: asked author for additional information regarding randomisation (conflicting statements in paper)

Tanissa 1951

Methods

Unknown, no full‐text paper or abstract

Participants

Interventions

Outcomes

Notes

Unknown Chinese author 1991

Methods

Unknown, no full‐text paper or abstract

Participants

Interventions

Outcomes

Notes

Characteristics of ongoing studies [ordered by study ID]

NCT02024581

Trial name or title

A Dose Range‐Finding Phase 2 Trial of a Botanical Drug for the Treatment of Molluscum Contagiosum in Pediatric Subjects (original title, later changed to: A Single‐center, Double‐blind, Placebo‐controlled, Randomized Safety and Efficacy Trial of a Botanical Drug Product, East Indian Sandalwood Oil (EISO), at One Dose Level for the Treatment of Molluscum Contagiosum in Pediatric Subjects

Methods

Double‐blind, randomised controlled trial

Participants

Children 2 to 17 years of age with molluscum contagiosum, in Texas USA, planned number of participants: 60

Interventions

10% East Indian sandalwood oil cream administered twice a day for 90 days versus placebo cream

Outcomes

The primary purpose of this study is to determine the safety profile of East Indian sandalwood. Safety will be assessed by evaluating adverse events with respect to severity, duration, and relationship to study drug compared to placebo.

Secondary outcomes: change in lesion count; improvement in Global Aesthetic Improvement Scale score; complete resolution of lesions; improvement in Evaluator's Global Severity Score.

Starting date

September 2015, estimated study completion date September 2016

Contact information

Dr John C Browning, [email protected]

Notes

See History of Changes in trial register (duration changed from 60 to 90 days; upper age limit changed; 3 strengths changed into 1; dates; title changed). Results of previously announced dose‐finding study unknown, asked by email July 2015.

Data and analyses

Open in table viewer
Comparison 1. Topical: 5% imiquimod versus vehicle

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

4

850

Risk Ratio (M‐H, Random, 95% CI)

1.33 [0.92, 1.93]

Analysis 1.1

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment) Show forest plot

2

702

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.67, 1.14]

Analysis 1.2

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

3 Secondary outcome: long‐term clinical cure (> 6 months after start of treatment) Show forest plot

2

702

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.79, 1.17]

Analysis 1.3

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 3 Secondary outcome: long‐term clinical cure (> 6 months after start of treatment).

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 3 Secondary outcome: long‐term clinical cure (> 6 months after start of treatment).

4 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment) Show forest plot

4

850

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.89, 1.47]

Analysis 1.4

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 4 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment).

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 4 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment).

5 Secondary outcome: medium‐term clinical improvement (after 3 and up to 6 months after start of treatment) Show forest plot

2

702

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.87, 1.08]

Analysis 1.5

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 5 Secondary outcome: medium‐term clinical improvement (after 3 and up to 6 months after start of treatment).

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 5 Secondary outcome: medium‐term clinical improvement (after 3 and up to 6 months after start of treatment).

6 Secondary outcome: recurrence Show forest plot

2

175

Risk Ratio (M‐H, Random, 95% CI)

2.70 [0.31, 23.23]

Analysis 1.6

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 6 Secondary outcome: recurrence.

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 6 Secondary outcome: recurrence.

7 Secondary outcome: any side effect Show forest plot

3

827

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.88, 1.07]

Analysis 1.7

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 7 Secondary outcome: any side effect.

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 7 Secondary outcome: any side effect.

8 Secondary outcome: application site reaction Show forest plot

3

827

Risk Ratio (M‐H, Random, 95% CI)

1.41 [1.13, 1.77]

Analysis 1.8

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 8 Secondary outcome: application site reaction.

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 8 Secondary outcome: application site reaction.

9 Secondary outcome: severe application site reaction Show forest plot

3

827

Risk Ratio (M‐H, Random, 95% CI)

4.33 [1.16, 16.19]

Analysis 1.9

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 9 Secondary outcome: severe application site reaction.

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 9 Secondary outcome: severe application site reaction.

Open in table viewer
Comparison 2. Topical: 5% imiquimod versus cryospray

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 2.1

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

Analysis 2.2

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

3 Secundary outcome: recurrence Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 2.3

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 3 Secundary outcome: recurrence.

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 3 Secundary outcome: recurrence.

Open in table viewer
Comparison 3. Topical: 5% imiquimod versus 10% potassium hydroxide

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

2

67

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.46, 0.93]

Analysis 3.1

Comparison 3 Topical: 5% imiquimod versus 10% potassium hydroxide, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 3 Topical: 5% imiquimod versus 10% potassium hydroxide, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

2 Secondary outcome: any side effect Show forest plot

2

67

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.25, 1.81]

Analysis 3.2

Comparison 3 Topical: 5% imiquimod versus 10% potassium hydroxide, Outcome 2 Secondary outcome: any side effect.

Comparison 3 Topical: 5% imiquimod versus 10% potassium hydroxide, Outcome 2 Secondary outcome: any side effect.

Open in table viewer
Comparison 4. Topical: 10% lemon myrtle oil versus vehicle

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 4.1

Comparison 4 Topical: 10% lemon myrtle oil versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 4 Topical: 10% lemon myrtle oil versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Open in table viewer
Comparison 5. Topical: 10% benzoyl peroxide cream versus 0.05% tretinoin cream

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 5.1

Comparison 5 Topical: 10% benzoyl peroxide cream versus 0.05% tretinoin cream, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 5 Topical: 10% benzoyl peroxide cream versus 0.05% tretinoin cream, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Open in table viewer
Comparison 6. Topical: 10% potassium hydroxide versus saline

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 6.1

Comparison 6 Topical: 10% potassium hydroxide versus saline, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 6 Topical: 10% potassium hydroxide versus saline, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Open in table viewer
Comparison 7. Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 7.1

Comparison 7 Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 7 Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

2 Secondary outcome: short‐term improvement (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 7.2

Comparison 7 Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide, Outcome 2 Secondary outcome: short‐term improvement (up to 3 months after start of treatment).

Comparison 7 Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide, Outcome 2 Secondary outcome: short‐term improvement (up to 3 months after start of treatment).

Open in table viewer
Comparison 8. Topical: 10% potassium hydroxide versus 14% salicylic acid + 14% lactic acid

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 8.1

Comparison 8 Topical: 10% potassium hydroxide versus 14% salicylic acid + 14% lactic acid, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 8 Topical: 10% potassium hydroxide versus 14% salicylic acid + 14% lactic acid, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Open in table viewer
Comparison 9. Topical: 10% potassium hydroxide versus curettage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 9.1

Comparison 9 Topical: 10% potassium hydroxide versus curettage, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 9 Topical: 10% potassium hydroxide versus curettage, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Open in table viewer
Comparison 10. Topical 10% potassium hydroxide versus cryotherapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 10.1

Comparison 10 Topical 10% potassium hydroxide versus cryotherapy, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 10 Topical 10% potassium hydroxide versus cryotherapy, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

2 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 10.2

Comparison 10 Topical 10% potassium hydroxide versus cryotherapy, Outcome 2 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment).

Comparison 10 Topical 10% potassium hydroxide versus cryotherapy, Outcome 2 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment).

Open in table viewer
Comparison 11. Topical: 10% povidone iodine versus 50% salicylic acid plaster

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 11.1

Comparison 11 Topical: 10% povidone iodine versus 50% salicylic acid plaster, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 11 Topical: 10% povidone iodine versus 50% salicylic acid plaster, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Open in table viewer
Comparison 12. Topical: 10% povidone iodine alone versus 10% povidone iodine and 50% salicylic plaster

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 12.1

Comparison 12 Topical: 10% povidone iodine alone versus 10% povidone iodine and 50% salicylic plaster, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 12 Topical: 10% povidone iodine alone versus 10% povidone iodine and 50% salicylic plaster, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Open in table viewer
Comparison 13. Topical: 10% povidone iodine and 50% salicylic acid plaster versus 50% salicylic plaster alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 13.1

Comparison 13 Topical: 10% povidone iodine and 50% salicylic acid plaster versus 50% salicylic plaster alone, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 13 Topical: 10% povidone iodine and 50% salicylic acid plaster versus 50% salicylic plaster alone, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Open in table viewer
Comparison 14. Topical: 0.7% cantharidin versus vehicle

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment). Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 14.1

Comparison 14 Topical: 0.7% cantharidin versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment)..

Comparison 14 Topical: 0.7% cantharidin versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment)..

Open in table viewer
Comparison 15. Topical: 5% sodium nitrite in 5% salicylic acid versus 5% salicylic acid alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 15.1

Comparison 15 Topical: 5% sodium nitrite in 5% salicylic acid versus 5% salicylic acid alone, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 15 Topical: 5% sodium nitrite in 5% salicylic acid versus 5% salicylic acid alone, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Open in table viewer
Comparison 16. Topical: 12% salicylic acid versus 70% alcohol

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 16.1

Comparison 16 Topical: 12% salicylic acid versus 70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Comparison 16 Topical: 12% salicylic acid versus 70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Open in table viewer
Comparison 17. Topical: 12% salicylic acid versus 10% phenol/70% alcohol

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 17.1

Comparison 17 Topical: 12% salicylic acid versus 10% phenol/70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Comparison 17 Topical: 12% salicylic acid versus 10% phenol/70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Open in table viewer
Comparison 18. Topical: 14% salicylic acid + 14% lactic acid versus curettage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 18.1

Comparison 18 Topical: 14% salicylic acid + 14% lactic acid versus curettage, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 18 Topical: 14% salicylic acid + 14% lactic acid versus curettage, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Open in table viewer
Comparison 19. Topical: 70% alcohol versus 10% phenol/70% alcohol

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 19.1

Comparison 19 Topical: 70% alcohol versus 10% phenol/70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Comparison 19 Topical: 70% alcohol versus 10% phenol/70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Open in table viewer
Comparison 20. Topical: iodine versus tea tree oil

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 20.1

Comparison 20 Topical: iodine versus tea tree oil, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 20 Topical: iodine versus tea tree oil, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

2 Secondary outcome: improvement (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 20.2

Comparison 20 Topical: iodine versus tea tree oil, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).

Comparison 20 Topical: iodine versus tea tree oil, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).

Open in table viewer
Comparison 21. Topical: iodine versus tea tree oil combined with iodine

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 21.1

Comparison 21 Topical: iodine versus tea tree oil combined with iodine, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 21 Topical: iodine versus tea tree oil combined with iodine, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

2 Secondary outcome: improvement (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 21.2

Comparison 21 Topical: iodine versus tea tree oil combined with iodine, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).

Comparison 21 Topical: iodine versus tea tree oil combined with iodine, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).

Open in table viewer
Comparison 22. Topical: tea tree oil versus tea tree oil combined with iodine

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 22.1

Comparison 22 Topical: tea tree oil versus tea tree oil combined with iodine, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 22 Topical: tea tree oil versus tea tree oil combined with iodine, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

2 Secondary outcome: improvement (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 22.2

Comparison 22 Topical: tea tree oil versus tea tree oil combined with iodine, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).

Comparison 22 Topical: tea tree oil versus tea tree oil combined with iodine, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).

Open in table viewer
Comparison 23. Systemic: cimetidine versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary outcome: medium‐term clinical cure (after 3 months and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 23.1

Comparison 23 Systemic: cimetidine versus placebo, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 months and up to 6 months after start of treatment).

Comparison 23 Systemic: cimetidine versus placebo, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 months and up to 6 months after start of treatment).

2 Secondary outcome: medium‐term improvement (after 3 months and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 23.2

Comparison 23 Systemic: cimetidine versus placebo, Outcome 2 Secondary outcome: medium‐term improvement (after 3 months and up to 6 months after start of treatment).

Comparison 23 Systemic: cimetidine versus placebo, Outcome 2 Secondary outcome: medium‐term improvement (after 3 months and up to 6 months after start of treatment).

Open in table viewer
Comparison 24. Systemic: calcarea carbonica versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 24.1

Comparison 24 Systemic: calcarea carbonica versus placebo, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 24 Systemic: calcarea carbonica versus placebo, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Flow diagram of inclusion for this update.
Figuras y tablas -
Figure 1

Flow diagram of inclusion for this update.

Risk of bias table: review authors' judgements about each methodological quality item for each included study.
Figuras y tablas -
Figure 2

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

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 1.1

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).
Figuras y tablas -
Analysis 1.2

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 3 Secondary outcome: long‐term clinical cure (> 6 months after start of treatment).
Figuras y tablas -
Analysis 1.3

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 3 Secondary outcome: long‐term clinical cure (> 6 months after start of treatment).

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 4 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 1.4

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 4 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment).

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 5 Secondary outcome: medium‐term clinical improvement (after 3 and up to 6 months after start of treatment).
Figuras y tablas -
Analysis 1.5

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 5 Secondary outcome: medium‐term clinical improvement (after 3 and up to 6 months after start of treatment).

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 6 Secondary outcome: recurrence.
Figuras y tablas -
Analysis 1.6

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 6 Secondary outcome: recurrence.

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 7 Secondary outcome: any side effect.
Figuras y tablas -
Analysis 1.7

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 7 Secondary outcome: any side effect.

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 8 Secondary outcome: application site reaction.
Figuras y tablas -
Analysis 1.8

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 8 Secondary outcome: application site reaction.

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 9 Secondary outcome: severe application site reaction.
Figuras y tablas -
Analysis 1.9

Comparison 1 Topical: 5% imiquimod versus vehicle, Outcome 9 Secondary outcome: severe application site reaction.

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 2.1

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).
Figuras y tablas -
Analysis 2.2

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 3 Secundary outcome: recurrence.
Figuras y tablas -
Analysis 2.3

Comparison 2 Topical: 5% imiquimod versus cryospray, Outcome 3 Secundary outcome: recurrence.

Comparison 3 Topical: 5% imiquimod versus 10% potassium hydroxide, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 3.1

Comparison 3 Topical: 5% imiquimod versus 10% potassium hydroxide, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 3 Topical: 5% imiquimod versus 10% potassium hydroxide, Outcome 2 Secondary outcome: any side effect.
Figuras y tablas -
Analysis 3.2

Comparison 3 Topical: 5% imiquimod versus 10% potassium hydroxide, Outcome 2 Secondary outcome: any side effect.

Comparison 4 Topical: 10% lemon myrtle oil versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 4.1

Comparison 4 Topical: 10% lemon myrtle oil versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 5 Topical: 10% benzoyl peroxide cream versus 0.05% tretinoin cream, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 5.1

Comparison 5 Topical: 10% benzoyl peroxide cream versus 0.05% tretinoin cream, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 6 Topical: 10% potassium hydroxide versus saline, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 6.1

Comparison 6 Topical: 10% potassium hydroxide versus saline, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 7 Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 7.1

Comparison 7 Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 7 Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide, Outcome 2 Secondary outcome: short‐term improvement (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 7.2

Comparison 7 Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide, Outcome 2 Secondary outcome: short‐term improvement (up to 3 months after start of treatment).

Comparison 8 Topical: 10% potassium hydroxide versus 14% salicylic acid + 14% lactic acid, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 8.1

Comparison 8 Topical: 10% potassium hydroxide versus 14% salicylic acid + 14% lactic acid, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 9 Topical: 10% potassium hydroxide versus curettage, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 9.1

Comparison 9 Topical: 10% potassium hydroxide versus curettage, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 10 Topical 10% potassium hydroxide versus cryotherapy, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 10.1

Comparison 10 Topical 10% potassium hydroxide versus cryotherapy, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 10 Topical 10% potassium hydroxide versus cryotherapy, Outcome 2 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 10.2

Comparison 10 Topical 10% potassium hydroxide versus cryotherapy, Outcome 2 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment).

Comparison 11 Topical: 10% povidone iodine versus 50% salicylic acid plaster, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 11.1

Comparison 11 Topical: 10% povidone iodine versus 50% salicylic acid plaster, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 12 Topical: 10% povidone iodine alone versus 10% povidone iodine and 50% salicylic plaster, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 12.1

Comparison 12 Topical: 10% povidone iodine alone versus 10% povidone iodine and 50% salicylic plaster, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 13 Topical: 10% povidone iodine and 50% salicylic acid plaster versus 50% salicylic plaster alone, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 13.1

Comparison 13 Topical: 10% povidone iodine and 50% salicylic acid plaster versus 50% salicylic plaster alone, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 14 Topical: 0.7% cantharidin versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment)..
Figuras y tablas -
Analysis 14.1

Comparison 14 Topical: 0.7% cantharidin versus vehicle, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment)..

Comparison 15 Topical: 5% sodium nitrite in 5% salicylic acid versus 5% salicylic acid alone, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 15.1

Comparison 15 Topical: 5% sodium nitrite in 5% salicylic acid versus 5% salicylic acid alone, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 16 Topical: 12% salicylic acid versus 70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).
Figuras y tablas -
Analysis 16.1

Comparison 16 Topical: 12% salicylic acid versus 70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Comparison 17 Topical: 12% salicylic acid versus 10% phenol/70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).
Figuras y tablas -
Analysis 17.1

Comparison 17 Topical: 12% salicylic acid versus 10% phenol/70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Comparison 18 Topical: 14% salicylic acid + 14% lactic acid versus curettage, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 18.1

Comparison 18 Topical: 14% salicylic acid + 14% lactic acid versus curettage, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 19 Topical: 70% alcohol versus 10% phenol/70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).
Figuras y tablas -
Analysis 19.1

Comparison 19 Topical: 70% alcohol versus 10% phenol/70% alcohol, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment).

Comparison 20 Topical: iodine versus tea tree oil, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 20.1

Comparison 20 Topical: iodine versus tea tree oil, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 20 Topical: iodine versus tea tree oil, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 20.2

Comparison 20 Topical: iodine versus tea tree oil, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).

Comparison 21 Topical: iodine versus tea tree oil combined with iodine, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 21.1

Comparison 21 Topical: iodine versus tea tree oil combined with iodine, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 21 Topical: iodine versus tea tree oil combined with iodine, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 21.2

Comparison 21 Topical: iodine versus tea tree oil combined with iodine, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).

Comparison 22 Topical: tea tree oil versus tea tree oil combined with iodine, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 22.1

Comparison 22 Topical: tea tree oil versus tea tree oil combined with iodine, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Comparison 22 Topical: tea tree oil versus tea tree oil combined with iodine, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 22.2

Comparison 22 Topical: tea tree oil versus tea tree oil combined with iodine, Outcome 2 Secondary outcome: improvement (up to 3 months after start of treatment).

Comparison 23 Systemic: cimetidine versus placebo, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 months and up to 6 months after start of treatment).
Figuras y tablas -
Analysis 23.1

Comparison 23 Systemic: cimetidine versus placebo, Outcome 1 Secondary outcome: medium‐term clinical cure (after 3 months and up to 6 months after start of treatment).

Comparison 23 Systemic: cimetidine versus placebo, Outcome 2 Secondary outcome: medium‐term improvement (after 3 months and up to 6 months after start of treatment).
Figuras y tablas -
Analysis 23.2

Comparison 23 Systemic: cimetidine versus placebo, Outcome 2 Secondary outcome: medium‐term improvement (after 3 months and up to 6 months after start of treatment).

Comparison 24 Systemic: calcarea carbonica versus placebo, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).
Figuras y tablas -
Analysis 24.1

Comparison 24 Systemic: calcarea carbonica versus placebo, Outcome 1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment).

Summary of findings for the main comparison. Imiquimod versus vehicle for cutaneous molluscum contagiosum

Imiquimod versus vehicle for cutaneous molluscum contagiosum

Patient or population: molluscum contagiosum
Setting: dermatology outpatient departments
Intervention: topical imiquimod
Comparison: topical vehicle

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with topical vehicle

Risk with topical imiquimod

Short‐term clinical cure (up to 3 months after start of treatment) (completely cleared short term)
Assessed with: observer assessed
Follow‐up: mean 12 weeks

Study population

RR 1.33
(0.92 to 1.93)

850
(4 RCTs)

⊕⊕⊕○
MODERATE 1

Analysis 1.1

118 per 1000

156 per 1000
(108 to 227)

Medium‐term clinical cure (after 3 months and up to 6 months after start of treatment) (completely cleared medium term)
Assessed with: observer assessed
Follow‐up: mean 16 weeks

Study population

RR 0.88
(0.67 to 1.14)

702
(2 RCTs)

⊕⊕⊕○
MODERATE 2

Analysis 1.2

272 per 1000

239 per 1000
(182 to 310)

Long‐term clinical cure (beyond 6 months after start of treatment) (completely cleared long term)
Assessed with: observer assessed
Follow‐up: mean 28 weeks

Study population

RR 0.97
(0.79 to 1.17)

702
(2 RCTs)

⊕⊕⊕○
MODERATE 2

Analysis 1.3

401 per 1000

389 per 1000
(317 to 469)

Short‐term clinical improvement (up to 3 months after start of treatment)
Assessed with: observer assessed
Follow‐up: mean 12 weeks

Study population

RR 1.14
(0.89 to 1.47)

850
(4 RCTs)

⊕⊕⊕⊕
HIGH 3

Analysis 1.4

487 per 1000

555 per 1000
(433 to 716)

Any adverse effect

Study population

RR 0.97
(0.88 to 1.07)

827
(3 RCTs)

⊕⊕⊕⊕
HIGH 4

Analysis 1.7

688 per 1000

667 per 1000
(606 to 736)

Application site reactions

Study population

RR 1.41
(1.13 to 1.77)

827
(3 RCTs)

⊕⊕⊕○
MODERATE 5

Analysis 1.8. This outcome was not prespecified in our protocol.

261 per 1000

368 per 1000
(295 to 462)

Severe application site reactions

Study population

RR 4.33
(1.16 to 16.19)

827
(3 RCTs)

⊕⊕⊕○
MODERATE 5

Analysis 1.9. This outcome was not prespecified in our protocol.

7 per 1000

29 per 1000
(8 to 110)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

1Downgraded by one level due to imprecision (< 300 events). We decided not to downgrade for risk of bias as out of four studies, the largest three were judged to be at low risk of bias.

2Downgraded by one level due to imprecision (< 300 events). We decided not to downgrade for risk of bias as both studies were judged to be at low risk of bias.

3We decided not to downgrade for risk of bias as out of four studies, the largest three were judged to be at low risk of bias. We also decided not to downgrade for inconsistency as removing one outlier eliminated inconsistency but hardly affected pooled estimate.

4We decided not to downgrade for risk of bias as all three studies were judged to be at low risk of bias.

5Downgraded by one level due to imprecision (< 300 events). We decided not to downgrade for risk of bias as all three studies were judged to be at low risk of bias.

Figuras y tablas -
Summary of findings for the main comparison. Imiquimod versus vehicle for cutaneous molluscum contagiosum
Table 1. Treatment modalities and examples of references

Treatment class

Treatment modality

Included studies

Other studies

'Doing nothing'

Awaiting natural resolution

Olsen 2015; Takemura 1983

Placebo

Antony 2001; Eichenfield 2005; Manchanda 1997b; Paller 2005a; Paller 2005b

Surgical treatments

Cryotherapy

Al‐Mutairi 2010

Barton 2002; Caballero 1996; Salmanpour 2006

Curettage

Hanna 2006; Machado 2010

de Waard 1990; Simonart 2008

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

Adapalene

Scheinfeld 2007

Australian lemon myrtle oil

Burke 2004

Benzoyl peroxide

Saryazdi 2004

Bromogeramine

He 2001

Cantharidin

Coloe Dosal 2014; Hanna 2006

Funt 1961; Funt 1979; Ross 2004; Silverberg 2000

Cidofovir

Davies 1999; Toro 2000; Zabawski 1999

Diphencyprone

Kang 2005; Kyu 1993

Griseofulvin

Salmanpour 2006

Honey

Holt 2015

Hydrogen peroxide cream

Bigardi 2003; Semkova 2014

Hyperthermia

Gao 2016

Imiquimod

Al‐Mutairi 2010; Eichenfield 2005; Hanna 2006; Paller 2005a; Paller 2005b; Seo 2010; Theos 2004

Arican 2006; Barba 2001; Bayerl 2003; Hengge 2003; Lim 2003; Liota 2000; Metkar 2008; Skinner 2000; Skinner 2002; Syed 1998

Iodine

Markum 2012

Iodine combined with tea tree oil

Markum 2012

Milkweed

Behl 1970

Povidone iodine plus salicylic acid

Markum 2012; Ohkuma 1990

Phenol

Leslie 2005

Weller 1999

Podophyllotoxin (HIV patients)

Markos 2001; Syed 1994; Teilla‐Hamel 1996

Potassium hydroxide

Bazza 2007; Machado 2010; Seo 2010; Short 2006; Uçmak 2013

Metkar 2008; Romiti 1999; Romiti 2000

Retinoic acid

Hund 1975

Salicylic acid

Hanna 2006; Leslie 2005; Ohkuma 1990

Salicylic acid combined with lactic acid

Machado 2010

Salicylic acid combined with sodium nitrite

Ormerod 1999

Silver nitrate

Niizeki 1999

Tea tree oil

Markum 2012

Tretinoin

Saryazdi 2004

Yellow oxide of mercury

Davis 1896

Systemic treatments

Cimetidine

Antony 2001

Cunningham 1998; Dohil 1996; 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

Figuras y tablas -
Table 1. Treatment modalities and examples of references
Comparison 1. Topical: 5% imiquimod versus vehicle

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

4

850

Risk Ratio (M‐H, Random, 95% CI)

1.33 [0.92, 1.93]

2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment) Show forest plot

2

702

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.67, 1.14]

3 Secondary outcome: long‐term clinical cure (> 6 months after start of treatment) Show forest plot

2

702

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.79, 1.17]

4 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment) Show forest plot

4

850

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.89, 1.47]

5 Secondary outcome: medium‐term clinical improvement (after 3 and up to 6 months after start of treatment) Show forest plot

2

702

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.87, 1.08]

6 Secondary outcome: recurrence Show forest plot

2

175

Risk Ratio (M‐H, Random, 95% CI)

2.70 [0.31, 23.23]

7 Secondary outcome: any side effect Show forest plot

3

827

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.88, 1.07]

8 Secondary outcome: application site reaction Show forest plot

3

827

Risk Ratio (M‐H, Random, 95% CI)

1.41 [1.13, 1.77]

9 Secondary outcome: severe application site reaction Show forest plot

3

827

Risk Ratio (M‐H, Random, 95% CI)

4.33 [1.16, 16.19]

Figuras y tablas -
Comparison 1. Topical: 5% imiquimod versus vehicle
Comparison 2. Topical: 5% imiquimod versus cryospray

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3 Secundary outcome: recurrence Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 2. Topical: 5% imiquimod versus cryospray
Comparison 3. Topical: 5% imiquimod versus 10% potassium hydroxide

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

2

67

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.46, 0.93]

2 Secondary outcome: any side effect Show forest plot

2

67

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.25, 1.81]

Figuras y tablas -
Comparison 3. Topical: 5% imiquimod versus 10% potassium hydroxide
Comparison 4. Topical: 10% lemon myrtle oil versus vehicle

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 4. Topical: 10% lemon myrtle oil versus vehicle
Comparison 5. Topical: 10% benzoyl peroxide cream versus 0.05% tretinoin cream

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 5. Topical: 10% benzoyl peroxide cream versus 0.05% tretinoin cream
Comparison 6. Topical: 10% potassium hydroxide versus saline

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 6. Topical: 10% potassium hydroxide versus saline
Comparison 7. Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Secondary outcome: short‐term improvement (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 7. Topical: 2.5% potassium hydroxide versus 5% potassium hydroxide
Comparison 8. Topical: 10% potassium hydroxide versus 14% salicylic acid + 14% lactic acid

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 8. Topical: 10% potassium hydroxide versus 14% salicylic acid + 14% lactic acid
Comparison 9. Topical: 10% potassium hydroxide versus curettage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 9. Topical: 10% potassium hydroxide versus curettage
Comparison 10. Topical 10% potassium hydroxide versus cryotherapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Secondary outcome: short‐term clinical improvement (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 10. Topical 10% potassium hydroxide versus cryotherapy
Comparison 11. Topical: 10% povidone iodine versus 50% salicylic acid plaster

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 11. Topical: 10% povidone iodine versus 50% salicylic acid plaster
Comparison 12. Topical: 10% povidone iodine alone versus 10% povidone iodine and 50% salicylic plaster

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 12. Topical: 10% povidone iodine alone versus 10% povidone iodine and 50% salicylic plaster
Comparison 13. Topical: 10% povidone iodine and 50% salicylic acid plaster versus 50% salicylic plaster alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 13. Topical: 10% povidone iodine and 50% salicylic acid plaster versus 50% salicylic plaster alone
Comparison 14. Topical: 0.7% cantharidin versus vehicle

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment). Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 14. Topical: 0.7% cantharidin versus vehicle
Comparison 15. Topical: 5% sodium nitrite in 5% salicylic acid versus 5% salicylic acid alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 15. Topical: 5% sodium nitrite in 5% salicylic acid versus 5% salicylic acid alone
Comparison 16. Topical: 12% salicylic acid versus 70% alcohol

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 16. Topical: 12% salicylic acid versus 70% alcohol
Comparison 17. Topical: 12% salicylic acid versus 10% phenol/70% alcohol

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 17. Topical: 12% salicylic acid versus 10% phenol/70% alcohol
Comparison 18. Topical: 14% salicylic acid + 14% lactic acid versus curettage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 18. Topical: 14% salicylic acid + 14% lactic acid versus curettage
Comparison 19. Topical: 70% alcohol versus 10% phenol/70% alcohol

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary outcome: medium‐term clinical cure (after 3 and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 19. Topical: 70% alcohol versus 10% phenol/70% alcohol
Comparison 20. Topical: iodine versus tea tree oil

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Secondary outcome: improvement (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 20. Topical: iodine versus tea tree oil
Comparison 21. Topical: iodine versus tea tree oil combined with iodine

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Secondary outcome: improvement (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 21. Topical: iodine versus tea tree oil combined with iodine
Comparison 22. Topical: tea tree oil versus tea tree oil combined with iodine

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Secondary outcome: improvement (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 22. Topical: tea tree oil versus tea tree oil combined with iodine
Comparison 23. Systemic: cimetidine versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Secondary outcome: medium‐term clinical cure (after 3 months and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Secondary outcome: medium‐term improvement (after 3 months and up to 6 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 23. Systemic: cimetidine versus placebo
Comparison 24. Systemic: calcarea carbonica versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Primary outcome: short‐term clinical cure (up to 3 months after start of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 24. Systemic: calcarea carbonica versus placebo