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Kojima R, Miyake K, Shinohara R, Kushima M, Yui H, Otawa S, Horiuchi S, Yokomichi H, Akiyama Y, Ooka T, Yamagata Z. Association between filaggrin gene mutations and the clinical features of molluscum contagiosum: The Yamanashi Adjunct Study of the Japan Environment and Children's Study. J Dermatol 2024; 51:484-490. [PMID: 38414183 DOI: 10.1111/1346-8138.17157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 02/29/2024]
Abstract
Previous studies have reported swimming, atopic dermatitis, and filaggrin (FLG) gene mutations as risk factors for molluscum contagiosum (MC) infection. FLG gene mutations impair skin barrier function. The aim of this study was to determine the impact of FLG mutations on the incidence and clinical features of MC. We used data from 2036 children who participated in the Yamanashi Adjunct Study of the Japan Environment and Children's Study, a prospective, birth cohort study. A questionnaire for caregivers (when children were 4 and 8 years of age) asked about clinical features including previous MC incidence and treatment, number of MC lesions at first visit, and time to resolution. Participants underwent genotyping to detect six FLG mutations that are common in the Japanese population. A logistic regression model was used to analyze the association between MC incidence and FLG mutations, adjusted for potential confounders. The cumulative incidence of MC at age 8 years was 47.1%. Among participants with a history of MC, 67.6% had undergone curettage. FLG mutation was a significant risk factor for MC incidence (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.18-2.42). Swimming and atopic dermatitis were also significant risk factors for MC. There was no significant association between FLG mutation and the number of MC lesions at the first visit or the time to resolution of lesions. FLG mutation is a risk factor for MC incidence; however, FLG mutations do not affect the number of MC lesions at presentation or the time to resolution.
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Affiliation(s)
- Reiji Kojima
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Kunio Miyake
- Department of Epidemiology and Environmental Medicine, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hideki Yui
- Center for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Sayaka Horiuchi
- Department of Epidemiology and Environmental Medicine, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Department of Epidemiology and Environmental Medicine, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Yuka Akiyama
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Tadao Ooka
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
- Center for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
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2
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Keam SJ. Berdazimer Topical Gel, 10.3%: First Approval. Drugs 2024; 84:363-368. [PMID: 38409574 DOI: 10.1007/s40265-024-02012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Berdazimer topical gel, 10.3% (ZELSUVMI™) is a nitric oxide (NO) releasing topical gel developed by Novan Inc. (a Ligand Pharmaceuticals company) for the treatment of molluscum contagiosum (MC). Novan has used their proprietary NO-based technology platform (NITRICIL™), which stores gaseous NO species on large polymers, in the development of berdazimer topical gel, 10.3%. In January 2024, berdazimer topical gel, 10.3% was approved for the topical treatment of MC in adult and paediatric patients 1 year of age and older in the USA. This article summarizes the milestones in the development of berdazimer topical gel, 10.3% leading to this first approval for the treatment of MC.
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Affiliation(s)
- Susan J Keam
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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3
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Sugarman JL, Hebert A, Browning JC, Paller AS, Stripling S, Green LJ, Cartwright M, Enloe C, Wells N, Maeda-Chubachi T. Berdazimer gel for molluscum contagiosum: An integrated analysis of 3 randomized controlled trials. J Am Acad Dermatol 2024; 90:299-308. [PMID: 37804936 DOI: 10.1016/j.jaad.2023.09.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND An out-of-office therapeutic agent indicated for molluscum contagiosum is needed. OBJECTIVE To assess the efficacy and safety of berdazimer gel, 10.3% (a topical, antiviral, nitric oxide-releasing medication) versus vehicle. METHODS Berdazimer gel, 10.3% or vehicle was applied once daily to all molluscum contagiosum lesions for 12 weeks in patients ≥6 months with 3-70 mollusca. Efficacy assessment: complete lesion clearance and partial clearance at week 12. Safety and tolerability assessment: adverse events through week 24 and local skin reactions through week 12. RESULTS There were 1598 patients enrolled (n = 917 berdazimer, n = 681 vehicle). Berdazimer was superior to vehicle at week 12 in complete clearance rates, 30.0% versus 19.8% (odds ratio, 1.75; 95% CI, 1.38-2.23, P < .001). Subgroup analyses of primary efficacy showed consistent favorable efficacy for berdazimer across most subgroups, including age, sex, baseline lesion count, and disease duration. Berdazimer provided favorable outcome for partial clearance. Application-site pain (18.7% vs 4.8% in berdazimer vs vehicle) and erythema (11.7% vs 1.3%), mostly mild to moderate, were the most common local skin reactions. LIMITATIONS Berdazimer sodium in molluscum patients with lesions (B-SIMPLE) trials enrolled only US patients; no efficacy assessments beyond week 12. CONCLUSIONS Berdazimer gel, 10.3% showed favorable efficacy and safety across subgroups.
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Affiliation(s)
- Jeffrey L Sugarman
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Adelaide Hebert
- Department of Dermatology, UTHealth McGovern Medical School, Houston, Texas
| | | | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen Stripling
- Pediatric Department, Coastal Pediatric Research, Charleston, South Carolina
| | - Lawrence J Green
- Department of Dermatology, George Washington University School of Medicine, Washington, DC
| | | | | | - Nick Wells
- Syneos Health, Hampshire, United Kingdom
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Santacroce L, Magrone T. Molluscum Contagiosum Virus: Biology and Immune Response. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:151-170. [PMID: 38801577 DOI: 10.1007/978-3-031-57165-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Molluscum contagiosum virus is a poxvirus belonging to the Poxviridae family, which includes Orthopoxvirus, Parapoxvirus, Yantapoxvirus, Molluscipoxvirus, Smallpox virus, Cowpox virus and Monkeypox virus. MCV belongs to the genus Molluscipoxvirus and has a tropism for skin tissue. MCV infects keratinocytes and, after an incubation period of 2 weeks to 6 weeks, causes a breakdown of the skin barrier with the development of papules of variable size depending on the proper functioning of the immune response (both adaptive and acquired). MCV only infects humans and does not cause viraemia. MCV encodes for several inhibitory proteins responsible to circumvent the immune response through different signalling pathways. Individuals who can be infected with MCV are children, immunocompromised individuals such as organ transplant recipients and Human Immunodeficiency Virus (HIV)-infected individuals. Current treatments to manage MCV-induced lesions are different and include the use of immunomodulators, which, however, do not provide an effective response.
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Affiliation(s)
- Luigi Santacroce
- Section of Microbiology and Virology, Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Bari, Italy.
| | - Thea Magrone
- Section of Microbiology and Virology, Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Bari, Italy
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5
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Watjer RM, Bonten TN, Quint KD, Hasani MM, Numans ME, Eekhof JAH. Molluscum contagiosum survey - common approach and attitude towards treatment and research in Dutch general practice. BMC PRIMARY CARE 2023; 24:264. [PMID: 38057771 PMCID: PMC10702083 DOI: 10.1186/s12875-023-02226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Molluscum contagiosum (MC) can cause significant burden in children. So far, pharmacological treatment has not been proven beneficial. More rigorous interventions have not been well studied. Current guidelines advise a "wait and see" policy. However, children and their parents frequently visit their GP requesting intervention. Therefore, the aim of this study was to gain insight into the approach to MC by GPs and parents' expectations and to investigate willingness to participate in an interventional study. METHODS A survey study was carried out among GPs and parents using a questionnaire for each group inquiring about MC and potential study participation. Descriptive statistics were used to analyze results and logistical regression to investigate factors influencing participation. RESULTS The majority of GPs (88%) preferred an expectative approach; only 21% were willing to participate in a trial as proposed. GPs estimating ≥ 50% of parents would request treatment, were more likely to participate. Most responding parents did or would visit their GP requesting treatment. In contrast to GPs, 58% were willing to participate. Parents preferring cryotherapy or curettage were more likely to participate. CONCLUSION Our study demonstrated that the majority of GPs preferred a conservative approach, adhering to current guidelines. However, most parents preferred treatment to resolve MC and symptoms. Parents' willingness to participate was much higher than GP's, reflecting parents' desire for treatment. These findings underscore the need for continued therapeutic research. Careful preparation and selection of GPs and patients will be essential to ensure the feasibility of such an endeavor. TRIAL REGISTRATION This survey study was not part of a clinical trial.
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Affiliation(s)
- Roeland M Watjer
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
| | - Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Dermatology, Roosevelt Clinic, Rooseveltstraat 82A, 2321 BM, Leiden, The Netherlands
| | - Mohammad M Hasani
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Just A H Eekhof
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
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Zorec TM, Alm E, Lind Karlberg M, Advani R, Hošnjak L, Poljak M. Comprehensive analysis of 66 complete molluscum contagiosum virus (MOCV) genomes: characterization and functional annotation of 47 novel complete MOCV genomes, including the first genome of MOCV genotype 3, and a proposal for harmonized MOCV genotyping indexing. mBio 2023; 14:e0222423. [PMID: 37947415 PMCID: PMC10746250 DOI: 10.1128/mbio.02224-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023] Open
Abstract
Four molluscum contagiosum virus (MOCV) genotypes (MOCV1-4) and four subtype variants (MOCV1p, MOCV1va, MOCV1vb, and MOCV1vc) were partially characterized using restriction enzyme profiling in the early 1980s/1990s. However, complete genome sequences of only MOCV1 and MOCV2 are available. The evolutionary pathways of MOCV genotypes and subtype variants with unavailable sequences remain unclear, and also whether all MOCV genotypes/subtype variants can be reliably detected and appropriately categorized using available PCR-based protocols. We de novo fully characterized and functionally annotated 47 complete MOCV genomes, including two putative non-MOCV1/2 isolates, expanding the number of fully characterized MOCV genomes to 66. To ascertain the placement of any putative novel MOCV sequence into the restriction profiling typing scheme, we developed an original framework for extracting complete MOCV genome sequence-based restriction profiles and matching them with reference restriction profiles. We confirmed that two putative non-MOCV1/2 isolates represent the first complete genomes of MOCV3. Comprehensive phylogenomic, recombination, and restriction enzyme recognition site analysis of all 66 currently available MOCV genomes showed that they can be agglomerated into six phylogenetic subgroups (PG1-6), corresponding to the subtype variants from the pioneering studies. PG5 was a novel subtype variant of MOCV2, but no PGs corresponded to the subtype variants MOCV1vb or MOCV4. We showed that the phylogenetic subgroups may have diverged from the prototype MOCV genotype lineages following large-scale recombination events and hinted at partial sequence content of MOCV4 and direction of recombinant transfer in the events that spawned PG5 and the yet undetected subtype variant MOCV1vb.IMPORTANCEFour molluscum contagiosum virus (MOCV) genotypes (MOCV1-4) and four subtype variants were partially characterized using restriction enzyme profiling in the 1980s/1990s, but complete genome sequences of only MOCV1 and MOCV2 are available. The evolutionary pathways whereby genotypes/subtype variants with unavailable sequences emerged and whether all MOCVs can be detected using current diagnostic approaches remain unclear. We fully characterized 47 novel complete MOCV genomes, including the first complete MOCV3 genome, expanding the number of fully characterized genomes to 66. For reliably classifying the novel non-MOCV1/2 genomes, we developed and validated a framework for matching sequence-derived restriction maps with those defining MOCV subtypes in pioneering studies. Six phylogenetic subgroups (PG1-6) were identified, PG5 representing a novel MOCV2 subtype. The phylogenetic subgroups diverged from the prototype lineages following large-scale recombination events and hinted at partial sequence content of MOCV4 and direction of recombinant transfer in the events spawning PG5 and yet undetected MOCV1vb variant.
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Affiliation(s)
- Tomaž Mark Zorec
- Laboratory for Molecular Microbiology and Slovenian HIV/AIDS Reference Center, Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Erik Alm
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | | | - Reza Advani
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | - Lea Hošnjak
- Laboratory for Molecular Microbiology and Slovenian HIV/AIDS Reference Center, Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mario Poljak
- Laboratory for Molecular Microbiology and Slovenian HIV/AIDS Reference Center, Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Kakleas K, Sinha S, Wilson D, Stiefel G. Lemon Myrtle (Backhousia citriodora): An Alternative and Effective Treatment for Molluscum Contagiosum in Children with Atopic Dermatitis. Chin J Integr Med 2023; 29:1018-1020. [PMID: 37695447 DOI: 10.1007/s11655-023-3747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Konstantinos Kakleas
- Paediatric Allergy Clinic, Agia Sofia Children's Hospital, Athens, 11527, Greece.
| | - Shilpee Sinha
- Paediatric Allergy Clinic, Leicester Royal Infirmary Hospital, Leicester, LE1 5WW, UK
| | - Deborah Wilson
- Paediatric Allergy Clinic, Leicester Royal Infirmary Hospital, Leicester, LE1 5WW, UK
| | - Gary Stiefel
- Paediatric Allergy Clinic, Leicester Royal Infirmary Hospital, Leicester, LE1 5WW, UK
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8
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Lawson ML, Szari SM, Beachkofsky TM, Hrncir DE. Heterologous effect of influenza vaccination on molluscum contagiosum infection; a case report of siblings. BMC Pediatr 2023; 23:208. [PMID: 37127556 PMCID: PMC10150547 DOI: 10.1186/s12887-023-04019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Molluscum contagiosum virus (MCV) is a benign, common cutaneous infection predominantly affecting the younger pediatric population. Traditional treatments may be time consuming with variable efficacy. Time to spontaneous resolution is variable and treatment is often sought to shorten duration of infection, prevent further autoinoculation, prevent infectious spread to others and treat cosmetic intolerability. CASE PRESENTATION We present the case of two patients with complete, simultaneous clearance of their molluscum contagiosum infections after receiving a routine 2018 quadrivalent influenza vaccination. Neither patient has had recurrence of molluscum contagiosum or permanent scarring. We review trials of intralesional immunotherapy in treatment of cutaneous infections to theorize the mechanism of MCV infection clearance post influenza vaccination. CONCLUSION We propose a delayed-type hypersensitivity reaction was induced as a heterologous effect of the influenza vaccination, similar to that seen in current immunotherapy treatments. This is the first reported case of MCV-directed immune reaction with infection clearance after influenza vaccination.
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Affiliation(s)
- Michelle L Lawson
- Division of Adolescent Medicine, Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), 3100 Schofield Road Fort Sam Houston, TX, 78234, San Antonio, US.
| | - Sofia M Szari
- Department of Allergy and Immunology, SAUSHEC, San Antonio, TX, US
| | | | - David E Hrncir
- Defense Health Agency Public Health, Immunization Healthcare Division, San Antonio, TX, US
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Interventions for molluscum contagiosum: A systematic review and network meta-analysis with normalized entropy assessment. J Am Acad Dermatol 2023; 88:508-510. [PMID: 35868571 DOI: 10.1016/j.jaad.2022.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/17/2023]
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Browning JC, Cartwright M, Thorla I, Martin SA, Olayinka-Amao O, Maeda-Chubachi T. A Patient-Centered Perspective of Molluscum Contagiosum as Reported by B-SIMPLE4 Clinical Trial Patients and Caregivers: Global Impression of Change and Exit Interview Substudy Results. Am J Clin Dermatol 2023; 24:119-133. [PMID: 36287306 PMCID: PMC9870829 DOI: 10.1007/s40257-022-00733-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Molluscum contagiosum is often characterized by persistent lesions and bothersome symptomology. What patients with molluscum contagiosum and/or caregivers consider to be meaningful measures of therapeutic success is unknown. OBJECTIVE We aimed to collect patient experience data and assess Global Impression of Change from patients and/or caregivers participating in a large phase III molluscum contagiosum interventional trial. METHODS The Berdazimer Sodium In Molluscum Patients with LEsions (B-SIMPLE4) phase III study enrolled 891 patients with molluscum contagiosum. Patients were randomly assigned to berdazimer gel, 10.3% or vehicle gel applied once daily for 12 weeks. Assessments of participant and investigator perceptions of complete lesion clearance were collected at weeks 12 and 24 along with Global Impression of Change scores from 1 (very much improved) to 7 (very much worse). A subset of 30 B-SIMPLE4 patients participated in the patient/caregiver experience exit interview to evaluate bothersome signs and symptoms. RESULTS At week 12, among participants with a ≥ 75% molluscum contagiosum lesion count reduction from baseline (as assessed by investigators), 99% (373/376) reported improvement. Perceptions of complete clearance at week 12 were nearly 40% for both participant-reported and investigator-reported Global Impression of Change in berdazimer group vs 20% in the vehicle group: 82% (322/392) of participants in the berdazimer group and 60% (237/394) in the vehicle group reported their molluscum contagiosum lesions were either very much improved or much improved at week 12. Similarly, investigators scored 80% (314/393) of berdazimer and 54% (215/396) of vehicle participants as very much improved or much improved. From the exit interview, the mean duration of participant-reported molluscum contagiosum was nearly 2 years. The most frequently reported molluscum contagiosum-related signs and symptoms were itch (n = 20), scarring (n = 18), and pain (n = 13). Visibility and contagiousness of molluscum contagiosum were the most bothersome aspects to participants. The most frequently reported psychosocial impacts were self-consciousness (n = 15) and embarrassment (n = 14). Lesion clearance was an expectation of 28/30 study participants. Overall, 26/30 reported being very satisfied (n = 18) or satisfied (n = 8) with the changes in their disease over the duration of the trial; 23/30 stated that the change in lesion count was meaningful. A mean reduction of 18 lesions (76% decrease) from the baseline lesion count was reported by participants (n = 28). Although 22 of 28 had less than complete lesion clearance, 17 of 22 reported that the reduction in the number of lesions was meaningful. CONCLUSIONS Molluscum contagiosum lesion reductions, with or without complete clearance, may be considered a therapeutic "success" by the patient/caregiver. CLINICAL TRIAL REGISTRATION NCT04535531 (registered 2 September, 2020).
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Affiliation(s)
- John Caleb Browning
- Department of Dermatology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Martina Cartwright
- Medical Affairs, Novan, Inc., 4020 Stirrup Creek Drive, Suite 110, Durham, NC, 27703, USA
| | - Ira Thorla
- Dermatology, DelRicht Research, Baton Rouge, LA, USA
| | - Susan A Martin
- Patient-Centered Outcomes Assessment, RTI Health Solutions, Ann Arbor, MI, USA
| | | | - Tomoko Maeda-Chubachi
- Medical Affairs, Novan, Inc., 4020 Stirrup Creek Drive, Suite 110, Durham, NC, 27703, USA.
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Lacarrubba F, Micali G, Trecarichi AC, Quattrocchi E, Monfrecola G, Verzì AE. New Developing Treatments for Molluscum Contagiosum. Dermatol Ther (Heidelb) 2022; 12:2669-2678. [PMID: 36239905 PMCID: PMC9674806 DOI: 10.1007/s13555-022-00826-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
A large variety of treatments for molluscum contagiosum (MC) are available, but none are Food and Drug Administration (FDA) approved and there is no consensus on the optimal approach, mainly owing to a lack of high-level data. Physical modalities are widely used, but require repeated outpatient visits for administration, are painful and difficult to perform in children, and are associated with the possibility of residual scarring and post-inflammatory hypo- or hyperpigmentation. Two experimental topical drugs, a new standardized preparation of topical cantharidin, called VP-102, and a topical nitric oxide (NO)-releasing product containing berdazimer, called SB206, represent promising products that have been designed to overcome the limitations of current treatments. They have recently shown good results in terms of safety and efficacy in large cohorts of patients in phase III studies and have the potential to be the first FDA-approved therapies for the treatment of MC.
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Affiliation(s)
- Francesco Lacarrubba
- Dermatology Clinic, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
| | - Giuseppe Micali
- Dermatology Clinic, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | | | | | - Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Elisa Verzì
- Dermatology Clinic, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
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12
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Affiliation(s)
- Vikash S Oza
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
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13
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Browning JC, Enloe C, Cartwright M, Hebert A, Paller AS, Hebert D, Kowalewski EK, Maeda-Chubachi T. Efficacy and Safety of Topical Nitric Oxide-Releasing Berdazimer Gel in Patients With Molluscum Contagiosum: A Phase 3 Randomized Clinical Trial. JAMA Dermatol 2022; 158:871-878. [PMID: 35830173 PMCID: PMC9280611 DOI: 10.1001/jamadermatol.2022.2721] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Molluscum contagiosum (MC) is a highly contagious skin condition. Lesions may persist for months to years, and no US Food and Drug Administration-approved medications are currently available in the US. Objective To assess the efficacy and safety of berdazimer gel, 10.3%, a novel topical nitric oxide-releasing medication, in the treatment of MC. Design, Setting, and Participants This was a multicenter, vehicle-controlled, double-blind, phase 3 randomized clinical trial (B-SIMPLE4) conducted in 55 clinics (mostly dermatology and pediatric) in the US from September 1, 2020, to July 21, 2021. Eligible participants were 6 months or older and had from 3 to 70 raised MC lesions. Patients with sexually transmitted MC or with MC only in the periocular area were excluded. Interventions Patients were randomized to treatment with berdazimer gel, 10.3%, or vehicle gel, applied as a thin layer to all lesions once daily for 12 weeks. Main Outcomes and Measures The primary efficacy end point was complete clearance of all MC lesions at week 12. Safety and tolerability measures included adverse event frequency and severity, and assessment of local skin reactions and scarring. Data analyses were performed from August 31, 2021, to September 14, 2021. Results A total of 891 participants were randomized, 444 to berdazimer, 10.3% (mean [range] age, 6.6 [0.9-47.5] years; 228 [51.4%] male; 387 [87.2%] White individuals), and 447 to vehicle (mean [range] age, 6.5 [1.3-49.0] years; 234 [52.3%] female; 382 [85.5%] White individuals). In the intention-to-treat population, 88.5% (393 patients) in the berdazimer group and 88.8% (397 patients) in the vehicle group had a lesion count performed at week 12. At week 12, 32.4% (144 patients) in the berdazimer group achieved complete clearance of MC lesions compared with 19.7% (88 patients) in the vehicle group (absolute difference, 12.7%; odds ratio, 2.0; 95% CI, 1.5-2.8; P < .001) with 14.4% (64 patients) of the berdazimer group discontinuing treatment because of MC clearance compared with 8.9% (40 patients) of the vehicle group. Adverse event rates were low. The most common adverse events were application-site pain and erythema, mostly mild in severity. Adverse events leading to discontinuation affected 4.1% (18 patients) of the berdazimer group and 0.7% (3 patients) of the vehicle group. The most common local skin reaction was mild to moderate erythema. Conclusions and Relevance Use of berdazimer gel, 10.3%, for MC appears to demonstrate favorable efficacy and safety with low adverse event rates. Trial Registration ClinicalTrials.gov Identifier: NCT04535531.
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Affiliation(s)
| | | | | | - Adelaide Hebert
- University of Texas Health McGovern Medical School, Houston, Texas
| | - Amy S Paller
- The Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - David Hebert
- Novan Inc, Durham, North Carolina.,Radius Health Inc, Boston, Massachusetts
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Maeda-Chubachi T, Hebert D, Messersmith E, Siegfried EC. SB206, a Nitric Oxide-Releasing Topical Medication, Induces the Beginning of the End Sign and Molluscum Clearance. JID INNOVATIONS 2021; 1:100019. [PMID: 34909721 PMCID: PMC8659381 DOI: 10.1016/j.xjidi.2021.100019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
The beginning of the end (BOTE) sign has been proposed to describe well-recognized clinical signs of inflammation (including erythema, induration, and scale) that predict imminent resolution of molluscum contagiosum (MC). This phenomenon has never been prospectively studied. An integrated analysis of two prospective, 12-week, randomized, double-blind clinical trials of topical nitric oxide–releasing SB206 gel evaluated an association between BOTE sign and MC lesion reduction. Of 707 randomized patients, ~80% exhibited BOTE signs regardless of treatment assignment. At week 12, MC lesion counts decreased from baseline by 50.7% for baseline BOTE+ versus 29.1% for BOTE– (P = 0.0015) vehicle-treated patients compared with a 63.3% decrease for baseline BOTE+ versus 51.7% for BOTE– (P = 0.0194) SB206-treated patients. Among vehicle-treated patients, 48 (22.3%) who were never BOTE+ had an 18.5% reduction from baseline in MC lesion counts versus a 34.0% reduction in 165 patients (76.7%) who experienced BOTE at any time, suggesting that the projected duration of lesion clearance for patients with 18–20 MC lesions is 15 months for BOTE– versus 6 months for BOTE+ patients. Patients who were both BOTE+ and treated with SB206 had the greatest reduction in MC lesion count. SB206 may trigger BOTE signs and shorten the duration of MC infection. The two studies whose data are analyzed in this study are registered at ClinicalTrials.gov with the identifiers NCT03927703 and NCT03927716
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Affiliation(s)
| | | | | | - Elaine C Siegfried
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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15
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Eichenfield LF, McFalda W, Brabec B, Siegfried E, Kwong P, McBride M, Rieger J, Willson C, Davidson M, Burnett P. Safety and Efficacy of VP-102, a Proprietary, Drug-Device Combination Product Containing Cantharidin, 0.7% (w/v), in Children and Adults With Molluscum Contagiosum: Two Phase 3 Randomized Clinical Trials. JAMA Dermatol 2021; 156:1315-1323. [PMID: 32965495 PMCID: PMC7512131 DOI: 10.1001/jamadermatol.2020.3238] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Question What is the efficacy and safety of VP-102, a drug-device combination containing cantharidin, 0.7% (w/v), in individuals aged 2 years or older with molluscum contagiosum compared with vehicle? Findings In 2 identical phase 3 trials (Cantharidin Application in Molluscum Patients [CAMP-1 and CAMP-2]) with a total of 582 participants, topical application of VP-102 or vehicle every 21 days for a maximum of 4 treatments resulted in complete lesion clearance rates of 46.3% (CAMP-1) and 54.0% (CAMP-2) with VP-102 vs 18% (CAMP-1) and 13% (CAMP-2) with the vehicle. The most common adverse events were primarily mild to moderate and included application site vesicles, pain, and pruritus. Meaning The findings of these trials support the efficacy and safety of a proprietary cantharidin-based drug-device combination for treatment of molluscum contagiosum in children and adults. Importance Molluscum contagiosum (MC) is a common viral skin infection that primarily affects children. Cantharidin, a topical vesicant, has a long history of use for MC in compounded formulations, but the safety and efficacy of doses, regimens, and application methods have not been demonstrated in large-scale trials. Objective To determine the safety and efficacy of VP-102, a drug-device combination containing cantharidin, 0.7% (w/v), compared with vehicle in individuals with MC. Design, Setting, and Participants Two phase 3, randomized, double-blind, vehicle-controlled trials of identical design (Cantharidin Application in Molluscum Patients [CAMP-1 and CAMP-2]) were conducted in 31 centers across the US. A total of 528 individuals aged 2 years or older with MC participated. CAMP-1 was conducted from March 21 to November 26, 2018, and CAMP-2 was conducted from February 14 to September 26, 2018. Interventions Participants were randomized (3:2) to topical application of VP-102 or vehicle to all treatable lesions every 21 days until complete lesion clearance or up to 4 treatments. Main Outcomes and Measures The primary efficacy outcome was the proportion of VP-102–treated participants achieving complete clearance of all MC lesions (baseline and new) compared with those who received the vehicle at the end-of-study visit on day 84. Intent-to-treat analysis was conducted for the efficacy population. Secondary efficacy outcomes included the proportion of participants achieving complete clearance of lesions at days 21, 42, and 63. Safety outcomes included assessment of adverse events, including expected local skin reactions. Results Of the 528 participants enrolled, 527 received treatment (CAMP-1, n = 265; CAMP-2, n = 262). A total of 267 of 527 participants (50.7%) were male; mean (SD) ages for CAMP-1 and CAMP-2 were 7.5 (5.3) years and 7.4 (8.0) years for the VP-102 groups and 6.3 (4.7) years and 7.3 (6.7) years for the vehicle groups. Treatment with VP-102 demonstrated superior efficacy to vehicle in the percentage of participants with complete clearance of MC lesions at the end of the study visit for CAMP-1 (VP-102: 46.3% vs vehicle: 17.9%; P < .001) and CAMP-2 (VP-102: 54.0% vs vehicle: 13.4%; P < .001). Adverse events were observed in 99% (CAMP-1) and 95% (CAMP-2) of VP-102–treated participants and 73% (CAMP-1) and 66% (CAMP-2) of vehicle-treated participants. The most common adverse events included application site vesicles, pain, pruritus, erythema, and scab. Most adverse events were mild or moderate in severity. Conclusions and Relevance In the 2 phase 3 trials reported herein, VP-102 was statistically significantly superior to vehicle in achieving complete clearance of MC lesions at the end of the study visit in both trials, with adverse events that were generally mild to moderate and confined to application sites. These findings show that VP-102 is potentially an effective and safe treatment for MC, a common skin condition with no US Food and Drug Administration–approved treatments. Trial Registrations ClinicalTrials.gov Identifiers: NCT03377790 and NCT03377803
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Affiliation(s)
- Lawrence F Eichenfield
- School of Medicine, University of California, San Diego.,Department of Dermatology, Rady Children's Hospital, San Diego, California
| | | | - Bradford Brabec
- Midwest Children's Health Research Institute, Lincoln, Nebraska
| | - Elaine Siegfried
- Department of Pediatrics, St Louis University, St Louis, Missouri
| | - Pearl Kwong
- Solutions Through Advanced Research, Jacksonville, Florida
| | | | - Jayson Rieger
- Verrica Pharmaceuticals Inc, West Chester, Pennsylvania
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16
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Eichenfield LF, Siegfried E, Kwong P, McBride M, Rieger J, Glover D, Willson C, Davidson M, Burnett P, Olivadoti M. Pooled Results of Two Randomized Phase III Trials Evaluating VP-102, a Drug-Device Combination Product Containing Cantharidin 0.7% (w/v) for the Treatment of Molluscum Contagiosum. Am J Clin Dermatol 2021; 22:257-265. [PMID: 33599960 PMCID: PMC7973914 DOI: 10.1007/s40257-020-00570-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 10/26/2022]
Abstract
BACKGROUND Compounded cantharidin has been used for decades to treat molluscum contagiosum but lacks rigorous clinical evidence to support its safety and efficacy. VP-102 is a shelf-stable drug-device combination product that contains topical cantharidin (0.7% weight/volume [w/v]) and is being evaluated for the treatment of molluscum. OBJECTIVES Our objective was to present pooled safety and efficacy analyses of VP-102 in the treatment of molluscum compared with vehicle. METHODS Participants aged ≥ 2 years were randomized 3:2 to topical administration of VP-102 or vehicle in two randomized, double-blind, vehicle-controlled phase III trials. Study drug was applied to all baseline and new lesions once every 21 days until clear or for a maximum of four applications. Assessors blinded to treatment counted all lesions at each study visit. All adverse events (AEs) were documented. Data were pooled for analyses. RESULTS In total, 310 participants received VP-102 and 218 received vehicle. Mean age was 7.5 years (range 2-60) for VP-102 and 6.8 (2-54) for vehicle. Complete clearance of all molluscum lesions at day 84 occurred in 50% of VP-102 participants and 15.6% of vehicle recipients (p < 0.0001). Mean molluscum lesion counts decreased 76% for VP-102 and 0.3% for vehicle at day 84 (p < 0.0001). The most common AEs in the VP-102 group were application site blistering, pruritus, pain, and erythema, which were generally mild or moderate in severity. CONCLUSIONS Pooled analyses showed a significantly higher percentage of participants with complete molluscum lesion clearance and larger reductions in lesion counts with VP-102 than with vehicle. AEs were anticipated because of the pharmacodynamic properties of cantharidin. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT03377790 (first posted 19 December 2017) and NCT03377803 (first posted 19 December 2017). Video abstract: Pooled Results of Two Randomized Phase III Trials Evaluating VP 102, a Drug Device Combination Product Containing Cantharidin 0.7% (w/v) for the Treatment of Molluscum Contagiosum (MP4 131293 KB).
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17
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Paradise SL, Hu YWE. Infectious Dermatoses in Sport: A Review of Diagnosis, Management, and Return-to-Play Recommendations. Curr Sports Med Rep 2021; 20:92-103. [PMID: 33560033 DOI: 10.1249/jsr.0000000000000808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Infectious dermatoses represent a significant source of morbidity and missed athletic participation among athletes. Close quarters and skin trauma from contact sports can lead to outbreaks among teams and athletic staff. The National Collegiate Athletic Association and National Federation of State High School Associations have published guidance with recommended management and return-to-play criteria for common fungal, bacterial, viral, and parasitic rashes. In addition to rapidly diagnosing and treating infectious dermatoses, team physicians should counsel athletes and athletic staff on proper equipment care and personal hygiene to reduce infection transmission. Clinicians should always consult sport and athlete governing bodies for sport-specific recommendations.
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Affiliation(s)
- Scott L Paradise
- Navy Medicine Readiness and Training Command, Naval Hospital Guam, Agana Heights, GU
| | - Yao-Wen Eliot Hu
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA
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18
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Edwards S, Boffa MJ, Janier M, Calzavara-Pinton P, Rovati C, Salavastru CM, Rongioletti F, Wollenberg A, Butacu AI, Skerlev M, Tiplica GS. 2020 European guideline on the management of genital molluscum contagiosum. J Eur Acad Dermatol Venereol 2020; 35:17-26. [PMID: 32881110 DOI: 10.1111/jdv.16856] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 01/05/2023]
Abstract
Molluscum contagiosum is a benign viral epidermal infection associated with high risk of transmission. The guideline is focused on the sexually transmitted molluscum contagiosum. The diagnosis is clinical with characteristic individual lesions, termed 'mollusca', seen as dome-shaped, smooth-surfaced, pearly, firm, skin-coloured, pink, yellow or white papules, 2 - 5 mm in diameter with central umbilication. Dermoscopy may facilitate diagnosis. Therapeutic options are numerous, including physical treatments (cautery, curettage and cryotherapy), topical chemical treatments (e.g. podophyllotoxin and imiquimod) or waiting for spontaneous resolution in immunocompetent patients. In pregnancy, it is safe to use physical procedures (e.g. cryotherapy). Immunosuppressed patients develop severe and recalcitrant molluscum lesions that may require treatment with cidofovir, imiquimod or interferon. Patients with molluscum contagiosum infection should be offered to be screened for other sexually transmitted infections.
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Affiliation(s)
| | - M J Boffa
- Department of Dermatology, Sir Paul Boffa Hospital, Floriana, Malta
| | - M Janier
- STD Clinic, Hôpital Saint-Louis AP-HP and Hôpital Saint-Joseph, Paris, France
| | | | - C Rovati
- Dermatology Department, University of Brescia, Italy
| | - C M Salavastru
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Wollenberg
- Dept. of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - A I Butacu
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - M Skerlev
- Zagreb University Hospital and Zagreb University School Of Medicine, Zagreb, Croatia
| | - G S Tiplica
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
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Gualdi G, Pascalucci C, Panarese F, Prignano F, Giuliani F, Verga E, Amerio P, Verdolini R. Molluscum contagiosum in pediatric patients: to treat or not to treat? Could a personalized imiquimod regimen be the answer to the dilemma? J DERMATOL TREAT 2020; 33:443-448. [PMID: 32347136 DOI: 10.1080/09546634.2020.1762840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Although molluscum contagiosum virus (MCV) infection is a common disease widespread among children and young adults, there is no shared opinion on treatment that can be divided into physical, chemical, medical (immunomodulating or anti-viral). According to some authors, MCV is best left to clear by itself.Objectives: To assess the clearance of MCV lesions in a sample of pediatric patients. It compares outcomes in treated with Imiquimod cream, compared with non-treated patients.Methods: The sample consits of 48 pediatric patients affected by MVC clinically diagnosed. It was divided into two groups: Group I, treated with Imiquimod 5% cream once/day until the onset of a visible inflammatory reaction. Once the reaction was illicited, application was suspended until the irritation resolved. If the lesion was still present, drug was administered again using the same regimen. The cycle was repeated until complete clinical resolution. Group II, control, comprises non-treated patients. Follow up visits were carried out 12, 16, 20, 48, and 52 weeks from the beginning of treatment.Results: At week 20, all patients except one in the treated group were lesion free. Persistence of MCV lesions was documented in one patient only until week 48. In the control group all patients were still affected by MCV lesions during the follow-up period. Spontaneous clinical resolution of the infection was observed in only 2 patients at week 52. The results of the study show Imiquimod's significant efficacy.Conclusions: Our study is one of the few case-control studies in pediatric population carried out with such long-term follow-up. Efficacy of this personalized treatment, scarce recurrence, absence of cicatricial sequelae and lack of necessity for deep sedation, in the case of children with disseminated lesions, makes the use of Imiquimod the first line of treatment compared with other destructive treatments or with no-treatment at all.
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Affiliation(s)
- Giulio Gualdi
- Dermatologic Clinic, Department of Medicine and Ageing Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Chiara Pascalucci
- Dermatologic Clinic, Department of Medicine and Ageing Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Fabrizio Panarese
- Dermatologic Clinic, Department of Medicine and Ageing Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Francesca Prignano
- Dermatology Clinic/ASF Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Federica Giuliani
- Dermatologic Clinic, Department of Medicine and Ageing Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Emanuele Verga
- Department of Dermatology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Paolo Amerio
- Dermatologic Clinic, Department of Medicine and Ageing Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Roberto Verdolini
- Department of Dermatology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
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20
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Hebert AA, Siegfried EC, Durham T, de León EN, Reams T, Messersmith E, Maeda-Chubachi T. Efficacy and tolerability of an investigational nitric oxide-releasing topical gel in patients with molluscum contagiosum: A randomized clinical trial. J Am Acad Dermatol 2019; 82:887-894. [PMID: 31586600 DOI: 10.1016/j.jaad.2019.09.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although a variety of ablative, topical, and systemic therapies are used for molluscum contagiosum (MC), none has been well studied or approved by the US Food and Drug Administration. OBJECTIVES To compare the efficacy and tolerability of topical SB206 (berdazimer sodium gel coadministered with hydrogel) with vehicle. METHODS A 12-week, phase 2, multicenter, randomized, double-blind, vehicle-controlled clinical trial of topical SB206. RESULTS A total of 256 patients (mean age, approximately 7 years) participated. Of patients who completed 12 weeks of treatment (n = 217), all MC lesions cleared in 20.0% of patients who received vehicle compared with 13.2%, 41.0%, and 35.1% of patients treated with twice daily SB206 4%, 8%, and 12%, respectively, and 41.9% of patients treated with once daily SB206 12%. Application-site erythema occurred in 10.6% of patients treated with SB206. Application-site reactions were the most common adverse events leading to treatment discontinuation, affecting 2 patients (approximately 4%) in each of the SB206 4%, 8%, and 12% twice daily groups and 0 patients in the vehicle or SB206 12% once daily groups. LIMITATIONS A larger study is needed to confirm the efficacy of SB206 12% once daily and provide additional safety assessments. CONCLUSION Of the doses studied, SB206 12% applied once daily provided the best balance between MC lesion clearance and tolerability for evaluation in a larger study.
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Gerlero P, Hernández-Martín Á. Actualización sobre el tratamiento de moluscos contagiosos en los niños. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:408-415. [DOI: 10.1016/j.ad.2018.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/20/2017] [Accepted: 01/18/2018] [Indexed: 11/25/2022] Open
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23
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Frauches DDO, Siqueira CCDM, Mata TFDD. Tratamento de Molusco Contagioso em crianças: uma revisão sistemática de literatura. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2017. [DOI: 10.5712/rbmfc12(39)1468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Molusco contagioso é uma infecção cutânea, causada pelo Molluscipox vírus. Diante da inexistência de um tratamento específico, esta pesquisa tem como objetivo verificar, segundo a literatura recente, os melhores métodos de tratamento em crianças imunocompetentes. Métodos: Revisão sistemática de literatura realizada no PubMed, bem como no Lilacs, Scielo, Medline e demais bases de dados abrangidas na Biblioteca Virtual em Saúde (BVS), com publicações de 2010 a 2016. Para evitar viés, foram utilizadas recomendações do PRISMA. Critérios do Oxford Centre for Evidence-Based Medicine e do sistema GRADE foram usados para classificação do nível de evidência dos estudos. Resultados: Curetagem, laser pulsado de contraste, crioterapia, exérese cirúrgica, KOH 2,5%, 5% e 10%, ácido tricloroacétrico, combinação de ácido lático e ácido salicílico, tretinoína 0,05% apresentaram boa proporção de cura, facilidade de realização e tempo de resolução. Os métodos de injeção intralesional do antígeno da Cândida e da vacina MMR, dieta balanceada, óleo de Malaleuca alternifólia e Ingenol Mebutate 0,05% mostraram-se promissores. Entretanto, cantaridina e imiquimod 5% creme não foram recomendados. Conclusão: As evidências obtidas não permitem indicar um método preferencial. A escolha do método de tratamento deve ser individualizada. Recomenda-se realizar mais pesquisas voltadas para cultura do vírus.
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Kwon HS, Lee JH, Kim GM, Choi EH, Bae JM. Topical evening primrose oil as a possible therapeutic alternative in children with molluscum contagiosum. Clin Exp Dermatol 2017; 42:923-925. [PMID: 28940438 DOI: 10.1111/ced.13226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- H S Kwon
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon, 16247, Korea
| | - J H Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon, 16247, Korea
| | - G M Kim
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon, 16247, Korea
| | - E H Choi
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - J M Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon, 16247, Korea
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Bakke JR, Stein SL. Molluscum Contagiosum of the Gluteal Cleft: Observations and Implications for Management in Five Children. Pediatr Dermatol 2017; 34:e191-e195. [PMID: 28543922 DOI: 10.1111/pde.13170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Molluscum contagiosum (MC) is a common, self-limited skin infection caused by a double-stranded DNA virus of the family Poxviridae. Although the morphology of the disease is well described, MC presenting at unusual sites can exhibit atypical morphology, resulting in misdiagnosis. This observational, retrospective case series discusses the novel morphology of MC presenting in the intergluteal cleft of five children seen in the outpatient dermatology clinic of an academic medical center. We present this case series to highlight this novel presentation of MC in children and to emphasize a conservative approach to management given the sensitive location and the self-limited nature of the infection.
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Affiliation(s)
- Joshua R Bakke
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sarah L Stein
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago, Illinois
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van der Wouden JC, van der Sande R, Kruithof EJ, Sollie A, van Suijlekom‐Smit LWA, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev 2017; 5:CD004767. [PMID: 28513067 PMCID: PMC6481355 DOI: 10.1002/14651858.cd004767.pub4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Molluscum contagiosum is a common skin infection that is caused by a pox virus and occurs mainly in children. The infection usually resolves within months in people without immune deficiency, but treatment may be preferred for social and cosmetic reasons or to avoid spreading the infection. A clear evidence base supporting the various treatments is lacking.This is an update of a Cochrane Review first published in 2006, and updated previously in 2009. OBJECTIVES To assess the effects of specific treatments and management strategies, including waiting for natural resolution, for cutaneous, non-genital molluscum contagiosum in people without immune deficiency. SEARCH METHODS We updated our searches of the following databases to July 2016: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched six trial registers and checked the reference lists of included studies and review articles for further references to relevant randomised controlled trials. We contacted pharmaceutical companies and experts in the field to identify further relevant randomised controlled trials. SELECTION CRITERIA Randomised controlled trials of any treatment of molluscum contagiosum in people without immune deficiency. We excluded trials on sexually transmitted molluscum contagiosum and in people with immune deficiency (including those with HIV infection). DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed methodological quality, and extracted data from selected studies. We obtained missing data from study authors where possible. MAIN RESULTS We found 11 new studies for this update, resulting in 22 included studies with a total of 1650 participants. The studies examined the effects of topical (20 studies) and systemic interventions (2 studies).Among the new included studies were the full trial reports of three large unpublished studies, brought to our attention by an expert in the field. They all provided moderate-quality evidence for a lack of effect of 5% imiquimod compared to vehicle (placebo) on short-term clinical cure (4 studies, 850 participants, 12 weeks after start of treatment, risk ratio (RR) 1.33, 95% confidence interval (CI) 0.92 to 1.93), medium-term clinical cure (2 studies, 702 participants, 18 weeks after start of treatment, RR 0.88, 95% CI 0.67 to 1.14), and long-term clinical cure (2 studies, 702 participants, 28 weeks after start of treatment, RR 0.97, 95% CI 0.79 to 1.17). We found similar but more certain results for short-term improvement (4 studies, 850 participants, 12 weeks after start of treatment, RR 1.14, 95% CI 0.89 to 1.47; high-quality evidence). For the outcome 'any adverse effect', we found high-quality evidence for little or no difference between topical 5% imiquimod and vehicle (3 studies, 827 participants, RR 0.97, 95% CI 0.88 to 1.07), but application site reactions were more frequent in the groups treated with imiquimod (moderate-quality evidence): any application site reaction (3 studies, 827 participants, RR 1.41, 95% CI 1.13 to 1.77, the number needed to treat for an additional harmful outcome (NNTH) was 11); severe application site reaction (3 studies, 827 participants, RR 4.33, 95% CI 1.16 to 16.19, NNTH over 40).For the following 11 comparisons, there was limited evidence to show which treatment was superior in achieving short-term clinical cure (low-quality evidence): 5% imiquimod less effective than cryospray (1 study, 74 participants, RR 0.60, 95% CI 0.46 to 0.78) and 10% potassium hydroxide (2 studies, 67 participants, RR 0.65, 95% CI 0.46 to 0.93); 10% Australian lemon myrtle oil more effective than olive oil (1 study, 31 participants, RR 17.88, 95% CI 1.13 to 282.72); 10% benzoyl peroxide cream more effective than 0.05% tretinoin (1 study, 30 participants, RR 2.20, 95% CI 1.01 to 4.79); 5% sodium nitrite co-applied with 5% salicylic acid more effective than 5% salicylic acid alone (1 study, 30 participants, RR 3.50, 95% CI 1.23 to 9.92); and iodine plus tea tree oil more effective than tea tree oil (1 study, 37 participants, RR 0.20, 95% CI 0.07 to 0.57) or iodine alone (1 study, 37 participants, RR 0.07, 95% CI 0.01 to 0.50). Although there is some uncertainty, 10% potassium hydroxide appears to be more effective than saline (1 study, 20 participants, RR 3.50, 95% CI 0.95 to 12.90); homeopathic calcarea carbonica appears to be more effective than placebo (1 study, 20 participants, RR 5.57, 95% CI 0.93 to 33.54); 2.5% appears to be less effective than 5% solution of potassium hydroxide (1 study, 25 participants, RR 0.35, 95% CI 0.12 to 1.01); and 10% povidone iodine solution plus 50% salicylic acid plaster appears to be more effective than salicylic acid plaster alone (1 study, 30 participants, RR 1.43, 95% CI 0.95 to 2.16).We found no statistically significant differences for other comparisons (most of which addressed two different topical treatments). We found no randomised controlled trial evidence for expressing lesions or topical hydrogen peroxide.Study limitations included no blinding, many dropouts, and no intention-to-treat analysis. Except for the severe application site reactions of imiquimod, none of the evaluated treatments described above were associated with serious adverse effects (low-quality evidence). Among the most common adverse events were pain during application, erythema, and itching. Included studies of the following comparisons did not report adverse effects: calcarea carbonica versus placebo, 10% povidone iodine plus 50% salicylic acid plaster versus salicylic acid plaster, and 10% benzoyl peroxide versus 0.05% tretinoin.We were unable to judge the risk of bias in most studies due to insufficient information, especially regarding concealment of allocation and possible selective reporting. We considered five studies to be at low risk of bias. AUTHORS' CONCLUSIONS No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. We found moderate-quality evidence that topical 5% imiquimod was no more effective than vehicle in terms of clinical cure, but led to more application site reactions, and high-quality evidence that there was no difference between the treatments in terms of short-term improvement. However, high-quality evidence showed a similar number of general side effects in both groups. As the evidence found did not favour any one treatment, the natural resolution of molluscum contagiosum remains a strong method for dealing with the condition.
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Affiliation(s)
- Johannes C van der Wouden
- VU University Medical CenterDepartment of General Practice and Elderly Care Medicine, Amsterdam Public Health Research InstitutePO Box 7057AmsterdamNetherlands1007 MB
| | - Renske van der Sande
- Erasmus Medical CenterDepartment of General PracticePO Box 2040Room Ff303RotterdamNetherlands3000 CA
| | - Emma J Kruithof
- VU University Medical CenterDepartment of General Practice and Elderly Care Medicine, Amsterdam Public Health Research InstitutePO Box 7057AmsterdamNetherlands1007 MB
| | - Annet Sollie
- Maison Medical Bel Air154 Avenue Bel AirCarpentrasFrance1084200
| | - Lisette WA van Suijlekom‐Smit
- Erasmus Medical Center ‐ Sophia Children's HospitalDepartment of Paediatrics, Paediatric RheumatologyPO Box 2060RotterdamNetherlands3000 CB
| | - Sander Koning
- Erasmus Medical CenterDepartment of General PracticePO Box 2040Room Ff303RotterdamNetherlands3000 CA
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Gao YL, Gao XH, Qi RQ, Xu JL, Huo W, Tang J, Ren Y, Zheng S, Hong YX, Song B, Chen HD. Clinical evaluation of local hyperthermia at 44 °C for molluscum contagiosum: pilot study with 21 patients. Br J Dermatol 2017; 176:809-812. [PMID: 27377758 DOI: 10.1111/bjd.14849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y-L Gao
- Department of Dermatology, No. 1 Hospital of China Medical University, 155 N. Nanjing Street, Shenyang, 110001, China
| | - X-H Gao
- Department of Dermatology, No. 1 Hospital of China Medical University, 155 N. Nanjing Street, Shenyang, 110001, China
| | - R-Q Qi
- Department of Dermatology, No. 1 Hospital of China Medical University, 155 N. Nanjing Street, Shenyang, 110001, China
| | - J-L Xu
- Department of Dermatology, Nanshan District People's Hospital Affiliated to Guangdong Medical College, Shenzhen, 518052, China
| | - W Huo
- Department of Dermatology, No. 1 Hospital of China Medical University, 155 N. Nanjing Street, Shenyang, 110001, China
| | - J Tang
- Department of Dermatology, No. 1 Hospital of China Medical University, 155 N. Nanjing Street, Shenyang, 110001, China
| | - Y Ren
- Department of Dermatology, No. 1 Hospital of China Medical University, 155 N. Nanjing Street, Shenyang, 110001, China
| | - S Zheng
- Department of Dermatology, No. 1 Hospital of China Medical University, 155 N. Nanjing Street, Shenyang, 110001, China
| | - Y-X Hong
- Department of Dermatology, No. 1 Hospital of China Medical University, 155 N. Nanjing Street, Shenyang, 110001, China
| | - B Song
- Department of Dermatology, No. 1 Hospital of China Medical University, 155 N. Nanjing Street, Shenyang, 110001, China
- Cardiff Institute of Tissue Engineering and Repair, Cardiff University, Cardiff, CF14 4XY, U.K
| | - H-D Chen
- Department of Dermatology, No. 1 Hospital of China Medical University, 155 N. Nanjing Street, Shenyang, 110001, China
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28
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Maruani A. [What's new in pediatric dermatology?]. Ann Dermatol Venereol 2016; 142 Suppl 3:S26-35. [PMID: 26792412 DOI: 10.1016/s0151-9638(16)30004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The years 2014-2015 have been rich in paediatric dermatology news in varied areas. Randomized controlled trials including children have been performed, especially in the fields of vascular anomalies, infectiology and immuno-allergology; new classifications and guidelines have been established; scientific research has made new discoveries, including the molecular basis of pediatric nevi and melanoma; epidemiologic works on risk factors have highlighted the need for dermatologists to be aware of prevention (sun prevention but also obesity); and finally, the many publications have taken into account psychological issues in children, such as quality of life, pain, observance or acceptance.
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Affiliation(s)
- A Maruani
- Service de dermatologie, unité de dermatologie pédiatrique, hôpital Trousseau, avenue de la République, 37044 Tours Cedex 9 ; université François-Rabelais de Tours, INSERM U930, 37000 Tours, France.
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Abstract
PURPOSE OF REVIEW Warts and molluscum contagiosum are very common viral skin infections, usually presenting in childhood. Despite the large number of people affected by them, high-quality trials of treatment are few and treatment is often chosen on the basis of cost, convenience and tradition. RECENT FINDINGS Over recent years, two further trials of the most commonly used treatments for warts, salicylic acid and cryotherapy, have been performed and for molluscum contagiosum, there is growing evidence for the use of irritants. For both infections, there are new evaluations of immunological approaches to therapy. SUMMARY Strong, high-quality evidence for treatments used very frequently for warts or molluscum is still lacking, but recent publications have helped to strengthen or weaken belief in commonly used therapies and to add weight to the immunological approach to management.
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Wollenberg A, Oranje A, Deleuran M, Simon D, Szalai Z, Kunz B, Svensson A, Barbarot S, von Kobyletzki L, Taieb A, de Bruin-Weller M, Werfel T, Trzeciak M, Vestergard C, Ring J, Darsow U. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol 2016; 30:729-47. [DOI: 10.1111/jdv.13599] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/10/2015] [Indexed: 12/27/2022]
Affiliation(s)
- A. Wollenberg
- Department of Dermatology and Allergy; Ludwig-Maximilian-University; Munich Germany
| | - A. Oranje
- Department of Dermatology (Pediatric Dermatology and Hair); Dermicis Skin clinic; Alkmaar and Rotterdam The Netherlands
| | - M. Deleuran
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - D. Simon
- Department of Dermatology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - Z. Szalai
- Heim Pal Childrens Hospital; Budapest Hungary
| | - B. Kunz
- Dermatologikum; Hamburg Germany
| | - A. Svensson
- Department of Dermatology; University Hospital UMAS; Malmö Sweden
| | - S. Barbarot
- Department of Dermatology; University of Nantes; Nantes France
| | | | - A. Taieb
- Service de Dermatologie et Dermatologie Pédiatrique; Centre de référence pour les maladies rares de la peau; INSERM 1035; Université de Bordeaux; Talence France
| | - M. de Bruin-Weller
- Department of Dermatology; University of Utrecht; Utrecht The Netherlands
| | - T. Werfel
- Department of Dermatology; Hautklinik Linden; MHH; Hannover Germany
| | - M. Trzeciak
- Department of Dermatology, Venereology and Allergology; Medical University of Gdansk; Gdansk Poland
| | - C. Vestergard
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - J. Ring
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Munich Germany
- Christine Kühne Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - U. Darsow
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Munich Germany
- ZAUM - Center of Allergy & Environment; Munich Germany
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Olsen JR, Gallacher J, Finlay AY, Piguet V, Francis NA. Quality of life impact of childhood skin conditions measured using the Children's Dermatology Life Quality Index (CDLQI): a meta-analysis. Br J Dermatol 2016; 174:853-61. [PMID: 26686685 DOI: 10.1111/bjd.14361] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Children's Dermatology Life Quality Index (CDLQI) is the most widely used instrument for measuring the impact of skin disease on quality of life (QoL) in children. OBJECTIVES To provide a meta-analysis of all published QoL scores for a range of childhood skin conditions. METHODS Studies using the CDLQI questionnaire to measure QoL in skin conditions were identified by searching Medline and Embase from January 1995 (CDLQI creation) to December 2014. Studies were grouped according to condition and baseline scores were combined using meta-analysis. RESULTS Sixty-seven studies using the CDLQI met the inclusion criteria. The overall estimated CDLQI scores for conditions reported more than once were [point estimate (95% confidence interval, CI), number of studies (n), score range]: atopic eczema [8·5 (7·1-9·8), n = 38, 0-29], acne [5·3 (1·9-8·5), n = 5, 0-30], alopecia [3·1 (0-7·7), n = 2, 0-6], molluscum contagiosum [3·5 (0·6-6·7), n = 5, 0-27], psoriasis [8·0 (3·9-12·1), n = 6, 0-29], scabies [9·2 (0·0-20·3), n = 2, 1-26], urticaria [7·1 (0-15·4), n = 2, 0-22], vitiligo [6·5 (0·7-12·2), n = 2, 0-20] and warts [2·9 (0-5·8), n = 4, 0-16]. Overall, the mean effect on QoL [weighted average CDLQI score 4·6 (95% CI 3·9-5·4)] for children with these conditions was small. However, many children were found to experience a very large impact on QoL (34% of children with atopic eczema, 10% with molluscum contagiosum and 1-5% with acne) in studies where the distributions of scores were provided. CONCLUSIONS Most skin conditions in children have a 'small' mean effect on QoL. However, the range is large and a significant proportion of children with many common skin conditions will experience a very large effect on quality of life.
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Affiliation(s)
- J R Olsen
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8RZ, U.K
| | - J Gallacher
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, OX3 7JX, U.K
| | - A Y Finlay
- Department of Dermatology and Academic Wound Healing, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, CF14 4XN, U.K
| | - V Piguet
- Department of Dermatology and Academic Wound Healing, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, CF14 4XN, U.K
| | - N A Francis
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, CF14 4YS, U.K
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Padilla España L, Mota-Burgos A, Martinez-Amo JL, Benavente-Ortiz F, Rodríguez-Bujaldón A, Hernández-Montoya C. Recalcitrant molluscum contagiosum successfully treated with sinecatechins. Dermatol Ther 2016; 29:217-8. [PMID: 26809498 DOI: 10.1111/dth.12338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - A Mota-Burgos
- Dermatology Department, Hospital de Poniente, El Ejido, Almeria, Spain
| | - J L Martinez-Amo
- Dermatology Department, Hospital de Poniente, El Ejido, Almeria, Spain
| | - F Benavente-Ortiz
- Dermatology Department, Hospital de Poniente, El Ejido, Almeria, Spain
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Molluscum contagiosum and associations with atopic eczema in children: a retrospective longitudinal study in primary care. Br J Gen Pract 2015; 66:e53-8. [PMID: 26639950 DOI: 10.3399/bjgp15x688093] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/18/2015] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Molluscum contagiosum (MC) is a common skin condition in children. Consultation rates and current management in primary care, and how these have changed over time, are poorly described. An association between the presence of atopic eczema (AE) and MC has been shown, but the subsequent risk of developing MC in children with a diagnosis of AE is not known. AIM To describe the consultation rate and management of MC in general practice in the UK over time, and test the hypothesis that a history of AE increases the risk of developing MC in childhood. DESIGN AND SETTING Two studies are reported: a retrospective longitudinal study of MC cases and an age-sex matched case-cohort study of AE cases, both datasets being held in the UK Clinical Practice Research Datalink from 2004 to 2013. METHOD Data of all recorded MC and AE primary care consultations for children aged 0 to 14 years were collected and two main analyses were conducted using these data: a retrospective longitudinal analysis and an age-sex matched case-cohort analysis. RESULTS The rate of MC consultations in primary care for children aged 0 to 14 years is 9.5 per 1000 (95% CI = 9.4 to 9.6). The greatest rate of consultations for both sexes is in children aged 1-4 years and 5-9 years (13.1 to 13.0 (males) and 13.0 to 13.9 (females) per 1000 respectively). Consultation rates for MC have declined by 50% from 2004 to 2013. Children were found to be more likely to have an MC consultation if they had previously consulted a GP with AE (OR 1.13; 95% CI = 1.11 to 1.16; P<0.005). CONCLUSION Consultations for MC in primary care are common, especially in 1-9-year-olds, but they declined significantly during the decade under study. A primary care diagnosis of AE is associated with an increased risk of a subsequent primary care diagnosis of MC.
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