Comparative Study of 5% Potassium Hydroxide Solution Versus 0.05% Tretinoin Cream for Molluscum Contagiosum in Children

4 pages
320 views

Please download to get full document.

View again

of 4
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Share
Description
jurnal kulit dan kelamin
Tags
Transcript
  VOL.9 | NO. 4 | ISSUE 36 | OCT 󰀭 DEC 2011 Page 291 Comparave Study of 5 % Potassium Hydroxide Soluon Versus 0.05% Trenoin Cream for Molluscum Contagiosum in Children ABSTRACT Background Molluscum contagiosum is one of the commonest cutaneous viral infecons in children. All treatment modalies are associated with substanal pain, ssue destrucon, and frequent recurrence. Objecves To compare the ecacy and side eects of KOH 5% soluon with trenoin 0.05% cream for the treatment of molluscum contagiosum in children. Methods Fiy paents were randomly divided into 2 groups; 25 each for 5% KOH soluon and 0.05% trenoin cream. The given medicaon was applied at bed me over molluscum lesions. The assessment of response and side eects were performed weekly for 4 weeks. Results At the end of 4 weeks, the mean lesion count decreased from 9.48±3.00 SD to 1.67±0.58 SD and from 8.35±2.82 SD to 2.00±1.00 SD in paents treated with 5% KOH soluon and 0.05% trenoin cream respecvely. Conclusion The result of both KOH and trenoin showed good response, well tolerated by children but between the two, KOH showed fast recovery and most lesions were resolved before 4 week. The side eects could be minimized if applied as stated above. On the other hand, trenoin showed delayed response and even some of lesion extended beyond 4 week but the side eect were less, and hence can be used in recurrent cases. KEY WORDS Molluscum, Potassium Hydroxide, trenoin Department of Dermatology Kathmandu University School of Medical Sciences Dhulikhel Hospital, Kathmandu University HospitalDhulikhel Hospital, Dhulikhel, Nepal Corresponding Author Eliz Aryal RajouriaDepartment of Dermatology Kathmandu University School of Medical Sciences Dhulikhel Hospital, Kathmandu University HospitalDhulikhel Hospital, Dhulikhel, NepalE-Mail: eliz_aryal@yahoo.com Citaon Rajouria EA, Amatya A, Karn D. Comparave Study of 5 % Potassium Hydroxide Soluon Versus 0.05% Trenoin Cream for Molluscum Contagiosum in Children Kathmandu Univ Med J  2011;36(4):291-4. Rajouria EA, Amatya A, Karn D INTRODUCTION Molluscum contagiosum, a cutaneous and mucosal erupon caused by a Molluscipox virus, was rst described and later assigned its name by Bateman in the beginning of the nineteenth century. 1  In 1841 Henderson and Paterson described the intra cytoplasmic inclusion bodies now known as molluscum or Henderson-Paterson bodies. 2  In the early tweneth century, Juliusberg, Wile, and Kingery were able to extract lterable virus from lesions and show transmissibility. 3  Molluscum contagiosum is one of the commonest cutaneous viral infecons in children. The infecon poses vexing treatment problems though various treatment opons are available, like cureage, cryosurgery, trichloroacec acid, cantharidin, etc. All treatment modalies are associated with substanal pain, ssue destrucon, and frequent recurrences, however these procedures are not well tolerated by children owing to pain and fear. 4,5 Potassium hydroxide (KOH) is known to penetrate deeply and destroy the skin because it dissolves keran. 6  Five percentage of KOH soluon has been prescribed for molluscum, to be applied at home and has added advantage of being relavely painless. 7 All-trans-renoic acid (trenoin) is easily available as cream base thought to involve the inducon of local irritaon which damages the viral protein-lipid membrane. 8 The aim of our study was to compare the ecacy and side eects of KOH 5% soluon with trenoin 0.05% cream for the treatment of molluscum contagiosum in children. Original Arcle  KATHMANDU UNIVERSITY MEDICAL JOURNAL Page 292 METHODS This is an open non randomized study carried out in a terary care centre aer obtaining permission from the instuonal ethical commiee. Fiy paents, ranging from six months to 14 years of age, aending the dermatology clinic, who presented with clinical features suggesve of Molluscum Contagiosum, were included in the study aer obtaining an informed consent from their parents or guardians. A detailed history was obtained, and paents underwent through general, systemic and cutaneous examinaon. Informaon regarding age, sex, number of lesions, duraon of illness, site of involvement, family history, history of atopy and previous treatment were collected. The inclusion criterion included paent with age group of six months to 14 years and paents who were willing to follow up every week for four weeks. Paents with more than 100 lesions, involvement of eyelid and genitalia, secondary infecon and history of hypersensivity to KOH or trenoin were excluded. Paents were randomly divided into two groups; 25 each for 5% KOH soluon and 0.05% trenoin cream. Parents or guardians were advised to apply petroleum jelly around the lesion at beginning and then with coon swab apply above medicaon at centre of the lesion according to assigned groups at bed me only. If accidental spillage occurred, they were advised to wash the skin with water immediately. Parents were asked to report local (erythema, itching, burning, pain, erosion, crusng) and systemic (fever, u like illness, diarrhoea, mylagia) side eects (g. 1 and 2) For stascal analysis, SPSS 16 was used. RESULTS Out of 50 paents, four paents were non complaint and did not follow up. Forty six paents were available for ecacy analysis (twenty three in each group). The age of paents ranged from one month to 14 years, out of which most were between two to four years. In this study 21 cases were males and 25 were females (Table 1). Table 1. Characteriscs of the study group. AGE years(SD)LESION (SD) Mean 4.3(2.9)8.9(2.9) SEX FrequencyPercent Female 2554.3 Male 2145.7 Total 46100 SITE FrequencyPercent Face 1941.3Extremies1123.9Abdomen/trunk1634.8 Total 46100 Maximum numbers of paents were having molluscum contagiosum since less than three months. The minimum duraon of infecon was 15 days and maximum duraon was six months. History of similar complaints in the family was noted in 11(23.9%) cases and history of atopy in eight (17.4%) cases. The number of lesions varied from 4-35 (mean 8.9). Out of 46 paents, 19 (41.3%) had lesions on the face while 11(23.9%) and 16 (34.8%) had lesion over extremies and abdomen/trunks respecvely. Response to treatment was seen irrespecve of duraon of disease and the site of involvement. The mean lesion count (mean number of molluscum) decreased from 9.48±3.00 SD to 1.67±0.58 SD) at end of four weeks in paents treated with KOH (Table 2). The number of lesion at any two junctures during follow up was compared by paired t-test. The comparison between the number of lesions at baseline (week 0) and the number of lesions at week four was found to be stascally signicant (P value 0.006) in KOH group (Table 2). Table 2. Comparison of the number of lesions at two points of me in two study groups. KOH (mean±SD)p-valueTrenoin (mean±SD)p-value Week 09.48±3.008.35±2.82Week 14.65±1.07<0.00011.72±0.57<0.0001Week 23.22±1.31 <0.00012.50±1.03<0.0001Week 32.31±1.14<0.00012.25±0.68<0.0001Week 41.67±0.580.00682.00±1.00<0.0001 The mean lesion count decreased from 8.35±2.82 SD to 2.00±1.00 SD at end of four week, with 0.05% trenoin cream. This reducon in number of lesion at end of 4 weeks was not signicant for trenoin (Table 2). The number of lesion at various junctures was compared between two groups by paired t- test (Table 3). In both the groups there was a signicant decrease in the number of lesions in inial two weeks, but in the laer two weeks, KOH showed greater decrease when compared with trenion. Figure 1. Dryness due to trenion.  VOL.9 | NO. 4 | ISSUE 36 | OCT 󰀭 DEC 2011 Page 293 Original Arcle Table 3. Comparison between the ecacies.   Duraon of treatmentMean ±SD (KOH)Mean ±SD (Trenoin)p-value Week 09.48±3.008.35±2.820.1948One week1.72 ±0.574.65±1.07<0.0001Two week3.22±1.312.50±1.030.0760Three week2.31±1.142.25±0.680.8519Four week1.67±0.582.00±1.000.5972 We observed that paents with KOH developed 36 side eects when compared with trenoin group that is 29. In the KOH group, paents showed dierent side eects than the trenoin group (Table 4). The commonest side eects observed were erythema and itching in both the groups. Most paents (KOH group) complained of crusng, edema, burning, erosion and one developed secondary bacterial infecon, which was conrmed on gram stain at second week of therapy. Two paents withdrew from study aer single applicaon of KOH due to severe burning sensaon. Most paents on trenoin had dryness (Fig 1), crusng, scaling and erythema. Table 4. Commonest side eect. Side eectsGroupKOH (n=23)N (%)Trenoin (n=23) N(%) Erythema 14 (73.7)10 (62.5) Erosion 6 (31.6)3 (18.8) Ulcer 1 (5.3)0 (0.0)Dryness1 (5.3)2 (12.5) Scaling 0 (0.0)4 (25.0) Burning 4 (21.1)3 (18.8)Itching3 (15.8)5 (31.3) Edema 5 (26.3)0 (0.0)Crusng2 (10.5)0 (0.0) DISCUSSION In our study molluscum contagiosum was common in age group of two-four years; similar result was noted in Fiji as two to three year and one to four year in Congo (Zaire). 9,10   History of atopy was found in eight (17.3%) paents in our study. Solomon et al gave clinical impression that molluscum contagiosum is commoner with atopic eczema. 11   Our study showed both treatment regimens to be equally eecve in the treatment of molluscum contagiosum with no signicant dierence in their ecacies. As trenoin has an-keranizaon and an-proliferaon acon, it take longer me; even can extend the period of study, with less side eects. 12   We found that side eects were more frequent with 5% KOH soluon. Romi et al also reported a study in which paents were instructed to apply 5% KOH soluon, which was done in an aempt to reduce the side eects observed with higher concentraon. 7  They found 5% KOH as eecve and less irritang when compared to KOH 10%. 7 Both of the study treatment regimens have advantage over other treatment opons as they are locally applicable, less traumac and painful. Because of these characteriscs, they can be easily applicable for the treatment of Mollascum Contagiosum. In addion to the above menons points, 5% KOH has other advantage of low cost and faster clearance of Molluscum Contagiosum. But higher irritancy characteriscs of the KOH soluon and need to be freshly prepare from fresh crystals are the lacking features in comparison to trenoin which is readily available in medical shops.Idencaon of early sign of irritaon and proper educaon about correct method of applicaon can minimise the side eect and early treatment of irritaon. CONCLUSION The result of both KOH and trenoin showed good response, well tolerated by children but between the two, KOH showed faster recovery and most lesions were resolved before four weeks. The side eect could be minimized if applied according as stated above. On the other hand, trenoin showed delayed response and even some of lesion extended beyond four weeks but the side eects were less, and can be used in recurrent cases. REFERENCES 1. Bateman F. Molluscum contagiosum. In: Shelley WB, Crissey JT, eds. Classics in Dermatology. Springeld IL; Charles C Thomas, 1953, p20. 2. Brown ST, Nalley JF, Kraus SJ. Molluscum contagiosum. Sex Transm Dis   1981; 8:227-34. 3. Juliusberg M. Zur Kenntnis des virus des Molluscum contagiosum. Dtsch Med Wochenschr   1905; 31:1598-9. 4. Bunney MH, Nolan MW, Williams DA. Assessment of method of treang viral warts by comparave treatment trials based on a standard design. Br J Dermatol   1976; 94:667-79. 5. Phelps WC, Alexander KA. Anviral therapy for human papillomaviruses: raonale and prospects.  Ann Intern Med    1995:123:368-82. Figure 2. Hyperpigmentaon with KOH.  KATHMANDU UNIVERSITY MEDICAL JOURNAL Page 294 6. Romi R, Ribeiro AP, Grinblat GM et al. Treatment of molluscum contagiosum with potassium hydroxide: A clinical approach in 35 children. Pediatr Dermol   1999; 16:228-31. 7. Romi R, Ribeiro AP,Romi N.Evaluaon of the eecveness of 5% potassium hydroxide for the treatment of molluscum contagiosum. Pediatr Dermol   2000;17:495 8. Lee R, Schwartz RA. Pediatric molluscum contagiosum: reecons on the last challenging poxvirus infecon, Part 2. Cus  2010; 86(6):287-92. 9. Postlethwaite R, Wa JA, Hawley TG et al. Features of molluscum contagiosum in the north –east of Scotland and in Fijian village selements . J Hyg (Lond)  1967; 65:281-91. 10. Torfs M. Consideraon sur le Molluscum Contagiosum en milieu tropical.  Ann Soc Belg Med Trop  1959; 39:703-9. 11. Solomon LM, Telner P. Erupve molluscum contagiosum in atopic dermas.  Can Med Assoc J  1966; 95:978-9. 12. Papa CM, Berger RS. Venereal herpes-likes molluscum contagiosum: treatment with trenoin. Cus  1976; 18:537-40.
Related Search
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks