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Ottawa, ON
-- Topical imiquimod 5% cream is a safe, well-tolerated, effective
treatment for molluscum contagiosum in children, said Ian
Landells, MD, at the annual meeting of the Canadian Dermatology
Association.
"Molluscum is a very common pathogen in the skin of
children, specifically molluscum contagiosum virus subtype 1,"
said Dr. Landells, assistant clinical professor of dermatology,
Memorial University St. John's, NF. It is a large double-stranded
DNA virus that usually resolves spontaneously in one or two years
but in the meantime it can spread and leave pitted scars.
Molluscum can be treated like warts. Topical retinoids are
sometimes the first line of treatment. Acid and blistering solutions,
cauterization, cryotherapy, and curettage are common. "Unfortunately,
the treatment is in most cases painful or poorly tolerated. Children
don't like the sight of their own blood," he said.
Four of five
children cleared
In a trial of
five immunocompetent children in St. John's, the immune response
modifier imiquimod was associated with complete clearance of molluscum
contagiosum in four children. They were at least two years old,
and they each had at least 20 lesions. The length of infection ranged
from six weeks to 18 months. They were treated with imiquimod 5%
cream three times a week for up to three months.
The first patient was a five-year-old male who had had molluscum
contagiosum for about six weeks. He had dozens of lesions and
had not been previously treated. The boy responded to treatment
with significant erythema and tolerable pruritus. New, inflamed
lesions also appeared. However at Month 2 the papules became significantly
less inflamed and no new papules had been noted in three weeks.
At Month 3 the erythema disappeared and only two papules remained.
Treatment was discontinued and the molluscum was completely clear
one month later.
A healthy six-year-old female was the second patient. She had a
two-month history of molluscum and no prior treatment. There was
no response at either Month 1 or 2. As new papules were developing,
her mother decided to remove her from the study.
The third patient was a five-year-old male. His family reported
no inflammation, but after the molluscum cleared Dr. Landells noted
post-inflammatory erythema. Treatment was stopped at Month 1, and
at Month 2 it was still clear with no erythema.
The fourth patient was an eight-year-old with a six-month history
of molluscum. At Month 1 there was some erythema, pruritus, and
inflamed lesions. At Month 2 there was a marked reduction of inflammation
and no new papules. At Month 3 there were post-inflammatory changes
and only two papules. Treatment was discontinued. No new lesions
developed and within two months there was complete clearance.
A six-year-old with an 18-month history was the fifth patient. The
patient had been treated several times with the blistering agent,
cantharidin. At Month 1 there was significant erythema and pruritus.
Treatment was stopped. At Month 2 there remained a slight redness
and some papules. At Month 3 the patient was completely clear: no
recurrence, no inflammation.
"So 80 per cent of patients that I saw achieved 90 per cent
or complete clearing in three months and went on to complete clearing
in four or five months," said Dr. Landells. "Pruritus
and erythema were the only adverse events and they were very well
tolerated."
Imiquimod activates the cytokine response by binding to Toll receptor
7. It is unclear why some patients do not respond. "The question
is whether or not the molluscum virus is able to deactivate
Toll receptor 7 or if it [the receptor] is absent in those patients
who don't seem to respond." The good news is that once molluscum
goes away it tends not to come back, he said.
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