Funtabulously Frivolous Friday Five 358

Verruca vulgaris (common warts) AND molluscum contagiosum.

In a small (n = 61) study in 2002, Focht et al tested duck tape vs cryotherapy to treat warts.  They found twenty-two patients (85%) in the duct tape arm vs 15 patients (60%) enrolled in the cryotherapy arm had complete resolution of their warts. 

The majority of warts that responded to either therapy did so within the first month of treatment.

With regards to molluscum, no single intervention has been shown to be convincingly effective.  ‘Treatments’ that exist include: 5% imiquimod cream, cryotherapy, enucleation, curettage 10% hydrogen peroxide, 5% hydrogen peroxide, 10% lemon myrtle oil, 10% benzoyl peroxide cream, 0.05% tretinoin cream, 14% salicylic acid cream, 50% salicylic acid plaster, 10% povidone iodine, 0.7% cantharidin and tea tree oil.

All but proving the old adage that if there are multiple therapies for a condition, it means that not one of them works particularly well. 

Cochrane found moderate quality evidence that topical 5% imiquimod was NO MORE effective than vehicle (cream without drug), but led to more application site reactions. However, high-quality evidence showed a similar number of general side effects in both groups.  Duck tape for molluscum has not been rigorously studied, but described to be at least as effective as any other method in case reports. 

Bonus question: Is it ‘duck’ tape OR ‘duct’ tape.

1. DUCK.

“Duck tape” is recorded in the Oxford English Dictionary as having been in use since 1899, and “duct tape” since 1965 as an alteration of the original term. The first material called “duck tape” was long strips of plain non-adhesive cotton duck cloth. Cotton duck or duck canvas is a more tightly woven version of plain canvas.

Reference:

• Lindau MS and Munar MY. Use of duct tape occlusion in the treatment of recurrent molluscum contagiosum. Pediatric Dermatology 2004;21(5):609-609

30% (actually 31.3%)

Increasing use of these imaging tests, an ageing population, and enhanced image resolution of modern machines are driving a surge in incidentalomas.

In a 2022 systematic review and meta-analysis by Evans et al, 147,763 ED encounters or radiology reports from 16 countries were analysed. Of these ~50% were in trauma patients, and the overall pooled prevalence estimate for any incidental finding was 31.3%.

Interestingly (or concerningly), among incidental findings recorded in radiology reports, the documentation of incidental findings in the ED records or patients’ discharge instructions was found anywhere from 20.1% to 47.2% of cases. In one study restricted to patients discharged from the ED, discharge paperwork mentioned the incidental findings in only one-tenth of cases.

Although early detection of progressive or malignant disease is beneficial, many or most incidentalomas prove benign BUT easily incur patient anxiety and harms from further investigation cascades, including complications of invasive procedures such as biopsies, radiation risk from follow‐up imaging, and opportunity costs and resource use for health care systems.

The American College of Radiology has developed aids and guidelines to assist in the management of incidentalomas. 

Reference:

• Scott IA, Slavotinek J and Glasziou PP. First do no harm in responding to incidental findings. Med J Aust ||  doi: 10.5694/mja2.52177 
• American College of Radiology – Incidental Findings App

Types of perianal abscess

About 90% of idiopathic perianal abscesses occur because of infection of the cryptoglobular glands. Most occur posteriorly and in the intersphincteric space, where the anal glands are located.

Perianal abscesses are twice as common in men as in women, with a mean age of 40 years in both sexes. Known risk factors associated with developing an abscess include inflammatory bowel disease, smoking, and HIV infection.  The most common presentations of abscesses are perianal (<60%) and ischiorectal.

Reference:

• Sahnan K et al. Perianal abscess. BMJ 2017;356:j475

Back problems (2) followed by arthritis (3).

The top 10 are:

• Mental and behavioural conditions – 26.1%
• Back problems – 15.7%
• Arthritis – 14.5%
• Asthma – 10.8%
• Diabetes – 5.3%
• Heart, stroke and vascular disease – 5.2%
• Osteoporosis – 3.4%
• Chronic Obstructive Pulmonary Disease (COPD) – 2.5%
• Cancer – 1.8%
• Kidney disease – 1.0%.

In Australia, 2022, 49.9% of people had at least one chronic condition. Females were more likely to have at least one chronic condition than males (52.3 to 47.4%). Almost one third (28.4%) people living in areas of most disadvantage had two or more chronic conditions, compared to one sixth (16.1%) of those living in areas of least disadvantage.

Age had interesting (but unsurprising) effects on prevalence:

Reference:

• Australian Bureau of Statistics: Health conditions prevalence. Accessed March 2024