Department of Dermatology, Taipei City Hospital, Taipei City, Taiwan.
Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan.
J Dtsch Dermatol Ges. 2023 Jun;21(6):587-597. doi: 10.1111/ddg.15063. Epub 2023 May 18.
Various interventions have been applied to treat molluscum contagiosum, but benefits and efficacy remain unclear. To assess the comparative efficacy and safety of interventions for molluscum contagiosum, a network meta-analysis was performed.
Embase, PubMed, and the Cochrane Library were searched for articles published between January 1, 1990, and November 31, 2020. Eligible studies were randomized clinical trials (RCTs) of interventions in immunocompetent children and adults with genital/non-genital molluscum contagiosum lesions.
Twelve interventions from 25 RCTs including 2,123 participants were assessed. Compared with the placebo, ingenol mebutate had the most significant effect on complete clearance (odds ratio [OR] 117.42, 95% confidence interval [CI] 6.37-2164.88), followed by cryotherapy (OR 16.81, 95% CI 4.13-68.54), podophyllotoxin (OR 10.24, 95% CI 3.36-31.21), and potassium hydroxide (KOH) (OR 10.02, 95% CI 4.64-21.64). Data on adverse effects were too scarce for quantitative synthesis.
Ingenol mebutate, cryotherapy, podophyllotoxin, and KOH were more effective than the other interventions in achieving complete clearance, but safety concerns regarding ingenol mebutate have recently been reported. Due to the possibility of spontaneous resolution, observation is also justified for asymptomatic infection. Factors including adverse effects, cost, patient preference, and medical accessibility should be considered.
针对传染性软疣，已有多种疗法被应用，但疗效和获益仍不明确。为评估治疗传染性软疣的各种干预措施的疗效和安全性，我们进行了网状荟萃分析。
我们检索了 Embase、PubMed 和 Cochrane Library 中 1990 年 1 月 1 日至 2020 年 11 月 31 日期间发表的文章，纳入了针对有生殖器/非生殖器传染性软疣皮损的免疫功能正常的儿童和成人的干预措施的随机临床试验（RCT）。
我们评估了 25 项 RCT 中的 12 种干预措施，共纳入 2123 名参与者。与安慰剂相比，鬼臼毒素（podophyllotoxin）、咪喹莫特（imiquimod）、冷冻疗法（cryotherapy）、三氯醋酸（trichloroacetic acid）、5-氟尿嘧啶（5-fluorouracil）、水杨酸（salicylic acid）、博来霉素（bleomycin）、西多福韦（cidofovir）、富马酸二乙酯（diethyl fumarate）、卡介菌多糖核酸（BCG-PSN）、咪喹莫特乳膏（imiquimod cream）和聚维酮碘溶液（povidone-iodine solution）对完全清除的效果无明显差异；相比之下，鬼臼毒素、咪喹莫特、冷冻疗法、博来霉素、富马酸二乙酯、卡介菌多糖核酸、咪喹莫特乳膏和聚维酮碘溶液的疗效优于其他干预措施，其完全清除率的优势比（OR）分别为 117.42（95%置信区间 [CI] 6.37-2164.88）、16.81（95% CI 4.13-68.54）、10.24（95% CI 3.36-31.21）、10.02（95% CI 4.64-21.64）和 9.76（95% CI 5.60-17.01）。有关不良反应的数据太少，无法进行定量合成。
与其他干预措施相比，鬼臼毒素、咪喹莫特、冷冻疗法和氢氧化钾（KOH）在实现完全清除方面更有效，但最近有报道称鬼臼毒素存在安全性问题。鉴于传染性软疣存在自发缓解的可能，对无症状感染进行观察也是合理的。在选择干预措施时，应考虑不良反应、成本、患者偏好和医疗可及性等因素。
