Molusco contagioso - Intervenção terapêutica na idade pediátrica. Revisão baseada na evidência

Abstract

Introduction: Molluscum contagiosum is a viral skin infection most frequently encountered in children between the ages of 2 and 5 years. In most cases the disease is self-limiting and resolves within 6 months to 2 years, but it may persist for up to 5 years. Treatment is given to re- lieve symptoms, to control the spread of lesions, to prevent scarring and secondary infection, and for cosmetic and social reasons. Aim: To assess the evidence for the efficacy and adverse events of treatments for molluscum contagiosum in immunocompetent children. Data sources: Medline, Cochrane Library, Dynamed, National Guideline Clearinghouse and evidence based medicine guidelines. Review methods: We performed a survey of clinical guidelines, systematic reviews, meta-analysis and clinical trials of treatment of mollus- cum contagiosum, published between January 2001 and September 2011, in Portuguese, English, French and Spanish, for children aged 18 years old or younger, using the MeSH term molluscum contagiosum. Exclusion criteria: sexually transmitted molluscum contagiosum and im- munocompromised children. The SORT (Strength of Recommendation Taxonomy) scale of the American Family Physician was used to grade the evidence. Results: Twenty-two studies were found. We selected two guidelines, one systematic review, one Dynamed summary and one randomized clinical trial for this review. There is evidence of efficacy with few adverse effects for topical treatment with Australian lemon myrtle oil or for curettage of lesions (strength of recommendation B). For topical treatments with benzoyl peroxide, imiquimod and cantharidin, the eviden- ce is weaker, as well as for systemic treatment with cimetidine and physical destruction of the lesions with cryotherapy (strength of recom- mendation C). No other evidence-based recommendations can be given for other treatments assessed. Conclusions: There is limited evidence to recommend treatment of molluscum contagiosum in children. Additional well-designed, prospec- tive studies are needed on therapeutic options compared to placebo or watchful waiting. Without good evidence for the efficacy and safety of treatment, watchful waiting must be considered.