|Year : 2016 | Volume
| Issue : 1 | Page : 1-3
A study on the efficacy of topical 10% potassium hydroxide in the treatment of Molluscum contagiosum
Fiona Frida Sequeira, Nanda Kishore Bala, Ganesh Kamath Hundi, Jacintha Martis
Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
|Date of Web Publication||21-Jan-2016|
Ganesh Kamath Hundi
Department of Dermatology, Father Muller Medical College, Kankanady, Mangalore - 575 002, Karnataka
Source of Support: None, Conflict of Interest: None
Context: Molluscum contagiosum (MC) is a highly contagious, nonsevere pediatric viral infection, with the current treatment modalities having negative aesthetic and psychological effects. Aims: To study the efficacy of 10% potassium hydroxide (KOH) solution in the treatment of MC. Materials and Methods: This prospective, open-labeled study was conducted in 40 patients who were clinically diagnosed with MC to know the efficacy of 10% KOH over a period of 18 months attending the outpatient department of Father Muller Medical College Hospital, Mangalore, Karnataka, India. Results: All the 40 patients (100%) showed complete clearance of lesions at the end of 4 weeks. The maximum number of patients belonged to the age group of less than 5 years, with the face being the most common site. Conclusion: Therapy with 10% KOH solution was found to be safe and effective in the treatment of MC.
Keywords: Molluscum, pox virus, 10% potassium hydroxide
|How to cite this article:|
Sequeira FF, Bala NK, Hundi GK, Martis J. A study on the efficacy of topical 10% potassium hydroxide in the treatment of Molluscum contagiosum. Muller J Med Sci Res 2016;7:1-3
|How to cite this URL:|
Sequeira FF, Bala NK, Hundi GK, Martis J. A study on the efficacy of topical 10% potassium hydroxide in the treatment of Molluscum contagiosum. Muller J Med Sci Res [serial online] 2016 [cited 2019 Jun 16];7:1-3. Available from: http://www.mjmsr.net/text.asp?2016/7/1/1/174604
| Introduction|| |
Molluscum contagiosum (MC) is a self-limiting, viral infection of the skin and mucous membrane seen in children and adults. In adults, it most commonly occurs as a sexually transmitted infection.  It is caused by MC virus of the genus Molluscipoxvirus, belonging to the Poxvirus family. Therapy is warranted to prevent autoinoculation and transmission although it is asymptomatic in healthy individuals. Most of the treatment modalities available such as freezing, curettage, evisceration, and laser are destructive and traumatize the lesions. In view of this, an alternative therapeutic approach consisting of topical 10% potassium hydroxide (KOH) solution was taken up, which can be used at home and is nontraumatizing to the patient. 
| Materials And Methods|| |
In this open-labeled study conducted over a period of 18 months from May 2005 to January 2007, 40 patients with MC attending the Outpatient Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India were included. Patients or their guardians were provided with standard information regarding the study and written informed consent was obtained. Patients with eyelid involvement, secondary infection, immunocompromised status, or those on immunosuppressive drugs were excluded from the study. Parents/patients were instructed to apply petroleum jelly to the perilesional area followed by application of 10% KOH solution to all the lesions twice daily with a plastic applicator at home. If the lesions underwent signs of inflammation or superficial ulceration during the course of treatment, the therapy was discontinued. The patients were followed up in the second week and fourth week after the treatment. Success of the treatment was judged by adopting a scale with a range from poor to excellent, with excellent being the complete disappearance of lesions. Therapy was discontinued in patients who developed local side effects while on treatment. Three months after treatment, follow-up was conducted to look for recurrence of lesions. The data were analyzed in the form of frequency, tables, and graphs.
| Results|| |
All the 40 patients completed the study. Females (55%) outnumbered the males (45%). The face (60%) was the most common site of involvement followed by the chest (20%) and upper limb (15%). Age group of the affected patients ranged from 5 months to 43 years with the maximum number of cases being of those who were less than 5 years of age (45%). All the 40 patients (100%) achieved complete clearance of lesions at the end of the fourth week [Figure 1] and [Figure 2]. However, one patient achieved clearance at the end of 2 weeks. New lesions were observed in three (7.5%) patients while on treatment.
The most common side effects reported were pigmentary disturbances, which consisted of both hyperpigmentation and hypopigmentation (82.5%) followed by a stinging sensation (67.5%). All the four patients (10%) with axillary lesions showed scarring. Recurrences were observed in three patients at the end of follow-up, with the recurrence rate being 7.5%.
|Figure 1: Lesions of molluscum contagiosum prior to the onset of treatment|
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|Figure 2: Resolution of the lesions after 4 weeks of treatment with 10% KOH solution|
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| Discussion|| |
MC is a self-limited viral infection in immunocompetent children and adults, which if untreated may resolve spontaneously.
A variety of therapeutic options are available, which are hospital-based; destructive substances such as podophyllin, phenol, silver nitrate, cantharidin, and tricholoroacetic acid have been used with variable results and require repeated sittings based upon their response.  Other physical modalities of treatments available include electrofulguration, cryotherapy, and laser.  Thus, the search for an alternative regimen using topical 10% KOH solution that can be used at home was taken up in this study. 
KOH is a strong alkali, which is known to digest proteins and lipids. It bears a keratolytic property that has been employed in treating hyperproliferative skin conditions and is routinely used to identify fungal filaments in skin scrapings. It can cause irritant reaction, which varies with the concentration and are known to penetrate deeply and destroy the skin because of their compounds that dissolve keratin.
All the 40 patients showed complete clearance of lesions at the end of 4 weeks. Males were affected more and the trunk was the common site in a study by Mahajan et al.  In our study, females outnumbered the males and the face was the most common site affected. In an open-labeled, uncontrolled study conducted by Romiti et al., all the 35 children treated with 10 % KOH achieved complete clearance of lesions after 30 days. Hypopigmentation was observed in five children. 
Pigmentary disturbance could be attributed to the concentration of KOH (10%) but in a study conducted by Romiti et al., pigmentary disturbances were not seen with 5% KOH applications. They concluded that 5% KOH proved to be as effective and less irritating when compared to 10% KOH. 
In a study conducted by Masood et al., 20% KOH solution was applied by multiple puncture technique with a 26-gauge needle. They observed that this technique reduced the need for repeated applications. A majority of the patients responded to a single application of KOH with minimal side effects. 
Seo et al.  considered 10% KOH solution as better over 5% imiquimod considering its lower cost and faster clearance of the lesions than the previous report of Metkar et al. (77% vs 44% in the KOH group).  Complete clearance of the lesions was observed in 37 out of 40 (92.5%) child patients receiving topical 10% KOH solution after a mean period of 4 weeks, as noted in a study by Can et al.  Handjani et al. in their study found both 10% KOH solution and cryotherapy to be equally effective but also added that 10% KOH was inexpensive and conferred better cosmetic results when compared to cryotherapy. 
10% KOH solution and salicylic and lactic acid combination were found to be equally effective in the treatment of MC in children in a study by Köse et al.
All the parents reported that topical 10% KOH solution was easy to apply and stated that they preferred to treat children at home instead of the more aggressive hospital-based physical modalities. Most patients felt a transient stinging sensation for 1-2 min shortly after the application. The present study emphasizes that topical 10% KOH is a safe, inexpensive, easy-to-apply, and effective mode of therapy that is useful in children because of noninvasive techniques and minimal side effects.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]