Randomized placebo-controlled clinical trial on efficacy and safety of topical 10% Potassium hydroxide for molluscum contagiosum treatment in children

Cutaneous Adverse Reactions Associated with Tattoos and Permanent Makeup Pigments

Tattooing is the procedure of implanting permanent pigment granules and additives into the dermal layer of the skin, serving various purposes such as decoration, medical identification, or accidental markings. There has been a significant rise in the popularity of decorative tattooing as a form of body art among both teenagers and young adults. Thus, the incidence of tattoos is increasing, with expanding applications such as permanent makeup, scar camouflage, nipple-areola, lips, and eyebrows tattooing, and utilization in oncological radiotherapy such as colon marking. However, there have been reported a broad range of adverse reactions linked to tattooing, encompassing allergic reactions, superficial and deep cutaneous infections, autoimmune disorders induced by the Koebner phenomenon, cutaneous tumors, and others. These reactions exhibit different onset times for symptoms, ranging from immediate manifestations after tattoo application to symptoms emerging several years later. Given the limited information on a tattoo's side effects, this review aims to elucidate the clinical spectrum of cutaneous complications of tattoos in different patients. The analysis will investigate both allergic and nonallergic clinical presentations of tattoo-related side effects, microscopic findings from skin biopsies, and therapeutic outcomes. This exploration is essential to improve our understanding of tattoo-related cutaneous complications and associated differential diagnoses and highlight the significance of patient awareness regarding potential risks before getting a tattoo.

A Therapeutic Trial Comparing Modified Autoinoculation, a Novel Approach with Topical Potassium Hydroxide Application in the Treatment of Molluscum Contagiosum

Context

Molluscum contagiosum (MC) is a common viral cutaneous infection. Despite multiple treatment options, there is no definitive treatment. In some cases, the lesions are severe, recurrent, and cosmetically odd. Modified autoinoculation (MAI) is a novel technique that induces cell-mediated immunity resulting in clearance of local as well as distant lesions. Potassium hydroxide (KOH) acts by dissolving the keratin and penetrating deeply destroys the hyperproliferative tissue. We would here like to compare MAI with topical KOH in the treatment of MC.

Aims and Objective

The aim of this study was to assess the effectiveness of MAI in treatment of MC and to compare its response with topical KOH application.

Settings and Design

This was an open-labeled longitudinal therapeutic outcome study carried out at a tertiary care center over a period of 1 year.

Materials and Methods

Hundred consenting MC patients attending the department of dermatology were randomized into Group A and Group B. Group A patients were subjected to MAI and Group B to topical application of 10% KOH.

Statistical Analysis Used

The continuous variables are presented as mean ± standard deviation (SD). The difference between the mean score was analyzed using Student's t test for independent variable and paired t test for paired results.

Results

At the end of 16 weeks, 91.48% showed complete clearance by MAI compared to 81.64% with topical 10% KOH solution. There was a significant reduction of mean score of lesions in patients treated by MAI compared to patients treated with KOH.

Conclusion

MAI therapy provides a promising, easy, cost-effective, daycare option for MC infections.

Efficacy of topical treatments for molluscum contagiosum in randomized controlled trials

Although molluscum contagiosum (MC) is a common infectious dermatosis that is self-resolving, treatment can diminish discomfort and decrease the risk of autoinoculation and infection to others, because it is transmitted through direct skin contact. This systematic review evaluates the efficacy of topical treatments for MC. A PubMed search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to find randomized, controlled trials of MC treatment. The search yielded 129 publications, but only 15 studies published between 1994 and 2020 were found to fit the inclusion criteria. Treatment modalities included podophyllotoxin, imiquimod, sodium nitrite, myrtle leaf extract, phenol, Salatac Gel (salicylic acid with lactic acid), potassium hydroxide, cantharidin, SB206, and VP-102. Outcomes were extracted from the literature, and subsequent quality and risk of bias assessments were performed. All treatments were more efficacious than the control except cantharidin, potassium hydroxide, and imiquimod, which had varying degrees of efficacy throughout studies. Overall, studies were of sufficient quality and had low risk of bias, but they had small sample sizes and lacked adequate explanation of statistical analysis. Current first-line treatment entails mechanical methods such as cryotherapy and curettage, which may be frightening to children with MC, so the development and assessment of topical treatments allows for alternative efficacious techniques.

The efficacy and safety of topical 10% potassium hydroxide for molluscum contagiosum: a systematic review and meta-analysis

BACKGROUND

Molluscum contagiosum (MC) is a self-limited cutaneous viral infection. Topical 10% potassium hydroxide (KOH) has been used for treating MC. However, it remains unclear whether it is beneficial or not to apply topical 10% KOH for treating MC.

METHODS

To confirm the efficacy and safety of topical 10% KOH compared with placebo as well as other treatments for MC, meta-analysis was used. Up to September 2020, we performed a comprehensive search of literature based on three databases with following keywords including 'molluscum contagiosum' and 'potassium hydroxide'.

RESULTS

Our meta-analyses demonstrated a significant difference between topical 10% KOH and placebo for complete clearance of MC (RR: 2.96, 95% CI: 1.69 - 5.17, p = .0001), while there were no statistical differences between them in the number of patients with adverse events (RR: 1.73, 95% CI: 0.67 - 4.45, p = .2562). Also, topical 10% KOH was as effective as mechanical treatments for MC (RR: 0.95, 95% CI: 0.84 - 1.07, p = .3833).

CONCLUSION

We demonstrate that application of topical 10% KOH may be one of effective and appropriate methods for the treatment of MC compared with awaiting spontaneous resolution due to its safety and effectiveness.