What are the treatment options for infected Molluscum contagiosum (a viral skin infection)?

From the Guidelines

Infected molluscum contagiosum should be treated with a combination of approaches targeting both the viral infection and secondary bacterial infection, prioritizing treatments that reduce morbidity, mortality, and improve quality of life. When considering treatment options, it's essential to weigh the potential benefits and risks of each approach. For the bacterial component, topical antibiotics like mupirocin 2% ointment applied three times daily for 7-10 days are typically effective, as they have been shown to reduce the risk of secondary bacterial infections 1.

Key Considerations

• For more severe infections, oral antibiotics such as cephalexin (500mg four times daily for adults; 25-50mg/kg/day divided into four doses for children) for 7-10 days may be necessary, but their use should be guided by clinical judgment and consideration of potential side effects 1.
• The underlying molluscum contagiosum lesions should still be addressed once the bacterial infection resolves, using treatments like cryotherapy, curettage, or topical therapies such as podophyllotoxin or imiquimod, with the goal of minimizing scarring and promoting healing 1.
• It's crucial to maintain good hygiene during treatment, including gentle cleansing with mild soap and water, avoiding sharing towels or clothing, and refraining from scratching to prevent spread, as these measures can help reduce the risk of transmission and secondary infections.
• Molluscum contagiosum is caused by a poxvirus that typically resolves on its own within 6-12 months, but treatment is recommended when lesions become infected, are numerous, or cause distress, as these factors can impact quality of life and increase the risk of complications 1.

Treatment Options

• Cryotherapy with liquid nitrogen has been used to treat lesions that occur in locations that are cosmetically bothersome to patients or for patients with underlying skin conditions such as eczema, but it may be associated with postinflammatory hyperpigmentation or scarring 1.
• Cantharidin has been shown to be an effective treatment of molluscum contagiosum in some studies, but its use should be guided by clinical judgment and consideration of potential side effects 1.
• Imiquimod was not shown to be of benefit compared with placebo in randomized controlled trials, and its use is not recommended as a first-line treatment for molluscum contagiosum 1.

From the FDA Drug Label

Imiquimod cream was evaluated in two randomized, vehicle-controlled, double-blind trials involving 702 pediatric subjects with molluscum contagiosum (MC) (470 exposed to imiquimod; median age 5 years, range 2-12 years). These studies failed to demonstrate efficacy

• Infected molluscum contagiosum is not directly addressed in the provided drug labels.
• The studies mentioned in the labels were for molluscum contagiosum, but they failed to demonstrate efficacy of imiquimod cream in treating the condition 2.
• There is no information on the treatment of infected molluscum contagiosum specifically.
• Therefore, no conclusion can be drawn about the use of imiquimod cream for infected molluscum contagiosum.

From the Research

Infected Molluscum Contagiosum

Overview of Molluscum Contagiosum

• Molluscum contagiosum is a common skin infection caused by a poxvirus, typically affecting young children, sexually active adults, and immunocompromised individuals 3.
• The infection is characterized by asymptomatic, flesh-colored papules with a central umbilication, usually resolving on its own but potentially leading to superinfection, scarring, autoinoculation, and transmission to others 3.

Treatment Options

• Various treatments have been used, including ablative regimens (curettage, electrodessication, cryotherapy, laser therapy) and topical or systemic pharmacologic agents (tretinoin, cantharidin, trichloroacetic and salicylic acid, potassium hydroxide, interferon-alfa, and cimetidine) 3.
• Topical imiquimod has been shown to be effective and safe in treating molluscum contagiosum in children, with a complete remission rate of 73.91% in one study 3.
• Dilute povidone-iodine has also been used as a novel at-home prescription treatment, demonstrating complete or partial resolution in all 12 patients (100%) in a case series 4.
• A Cochrane review found no single intervention to be convincingly effective, but moderate-quality evidence suggested that topical 5% imiquimod was no more effective than vehicle in terms of clinical cure, although it led to more application site reactions 5.

Considerations for Specific Populations

• Treatment selection should consider the specific clinical scenario, including patient age and immune status 6.
• Immunodeficient individuals may require special consideration, as their immune status can affect the course of the disease and response to treatment 6.
• Pediatric populations have been treated with various methods, including topical imiquimod and dilute povidone-iodine, with reported success rates 3, 4.

Adverse Effects and Safety

• Topical imiquimod has been associated with mild to moderate irritation in the application area, but no systemic side effects have been reported 3.
• Application site reactions were more frequent in groups treated with imiquimod, with a number needed to treat for an additional harmful outcome (NNTH) of 11 5.
• Other treatments, such as cryospray and potassium hydroxide, have also been associated with adverse effects, including pain during application, erythema, and itching 5.