Journal Club

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Journal Club

• September 11, 2006
• Tamika Brierley, MD

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Our patient. . .

• 5yo girl comes to clinic with multiple firm,
  fleshy lesions over her shoulder, neck and chin.
  Some of the lesions are umbilicated. Others are
  excoriated.

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Our patient, continued. . .

• You explain to the mother that these lesions are
  molluscum contagiosum, caused by a virus. You
  discuss the etiology and natural history of the
  rash, explaining that it may take months, but the
  rash will ultimately resolve on its own.
• She inevitably says, yes, but isnt there
  something you can do to make it go away faster???

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Clinical Question

• Is there a topical treatment that can speed the
  resolution of molluscum contagiosum lesions?

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Search

• PubMed
• Search molluscum contagiosum
• Limits all children (0-18 years), published in
  the past 2 years, clinical trial or randomized
  control trial, English, Human
• Resulted in 3 articles

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• K.S. Leslie, G. Dootson and J. C. Sterling.
  Topical salicylic acid gel as a treatment for
  molluscum contagiosum in children. Journal of
  Dermatological Treatment. 2005 16 336-340.

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Participants

• Children were referred from local general
  practitioners and pediatricians, trial conducted
  by outpatient dermatology clinics at a teaching
  hospital and a district general hospital
• 114 children were enrolled over a 4 year period
• Inclusion multiple MC lesions, parental consent
• Exclusion immunocompromised, severe eczema

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Are the results valid?

• Randomized to one of three groups salicylic
  acid, phenol or vehicle
• Groups were similar at beginning of trial
• Participants sought treatment for similar reasons

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Leslie, et al. Journal of Dermatological
Treatment, 2005.
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Leslie, et al. Journal of Dermatological
Treatment, 2005.
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Are the results valid?

• Single blinded for phenol and vehicle, no
  blinding for salicylic acid group
• Patients were treated in the clinic monthly
  (phenol and vehicle) salicylic acid also had
  monthly visits but were treated 1-2 x/ week at
  home
• All patients were given an aqueous moisturizer
  cream
• Participants were followed until resolution or to
  6 months, whichever came first
• Both an intention to treat and an as treated
  analysis were performed

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Leslie, et al. Journal of Dermatological
Treatment, 2005.
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Results

• Resolution of all lesions
• 16 of 36 ( 44.4 ) with vehicle
• 17 of 41 (41.5 ) with phenol
• 21 of 37 (56.8 ) with salicylic acid
• No significant differences between groups
• When analyzed as treated, statistical
  difference between phenol and salicylic acid
  groups only

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Time to Resolution
Leslie, et al. Journal of Dermatological
Treatment, 2005.
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Treatment Effect

• Phenol vs. Salicylic Acid
• RRR 26, ARR 0.15, NNT 7
• ARR CI -0.08 - 0.38
• NNT CI 3 - infinity
• Vehicle vs. Salicylic Acid
• RRR 22, ARR 0.12, NNT 8
• ARR CI -0.07 - 0.35
• NNT CI 3 - infinity

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Calculations

• RRR CER EER / CER
• ARR CER EER
• NNT 1 / ARR
• CI were calculated using the CATmaker stats
  program from the Oxford Centre for Evidence Based
  Medicine
• http//www.cebm.net/toolbox.asp

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Adverse Events

• No serious adverse effects
• All patients were asked about tolerability of
  treatment at first follow-up
• 0 vehicle, 2 phenol, and 5 salicylic acid
  patients chose to discontinue treatment
• Remainder found the treatment tolerable or
  fine

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Utility

• Can the results be applied to my patient?
• Yes
• Were all clinically relevant outcomes considered?
• No analyze time to resolution
• Are the treatment benefits worth the potential
  harms and costs?
• Yes

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Thanks!

• Rachel Chapman