From the Guidelines
The most effective treatment for molluscum contagiosum is cantharidin, as it has shown promise in open-label and observational studies, although its efficacy was not found to be statistically significant in a small randomized controlled trial 1. When considering treatment options, it's essential to weigh the potential benefits and risks, as well as the patient's individual circumstances.
- The use of 10% potassium hydroxide and cryotherapy with liquid nitrogen has been reported, but these methods may be associated with postinflammatory hyperpigmentation or scarring 1.
- Imiquimod was not shown to be of benefit compared with placebo in randomized controlled trials 1, making it a less desirable option. Key considerations for treatment include:
- The location and number of lesions
- The patient's underlying skin conditions, such as eczema
- The potential for cosmetic concerns or discomfort
- The need for ongoing monitoring and potential for new lesions to appear during treatment. In terms of specific treatment regimens, cantharidin (0.7% solution) applied by a healthcare provider to individual lesions and washed off after 2-6 hours is a viable option, although more research is needed to fully establish its efficacy 1.
From the FDA Drug Label
Imiquimod cream has been evaluated in children ages 2 to 12 years with molluscum contagiosum and these studies failed to demonstrate efficacy. The medications of choice for molluscum contagiosum are not explicitly stated in the provided drug labels.
- The studies involving imiquimod cream in pediatric subjects with molluscum contagiosum failed to demonstrate efficacy 2, 2.
- Imiquimod cream is not indicated for the treatment of molluscum contagiosum 2.
From the Research
Medications for Molluscum Contagiosum
- Topical imiquimod has been shown to be an effective and safe treatment for molluscum contagiosum in children, with a complete remission rate of 73.91% in one study 3.
- Topical cantharidin is also a commonly used treatment for molluscum contagiosum, with studies demonstrating its efficacy and safety in pediatric patients 4, 5.
- Combination therapy with cantharidin and imiquimod 5% has been shown to be effective and well-tolerated in children with molluscum contagiosum, with >90% of lesions clearing in 12 patients in one study 6.
- Cantharidin is a practical and effective treatment option for molluscum contagiosum, with detailed information on distribution sources, application, and caveats regarding its use available 7.
Treatment Options
- Imiquimod: a topically applicable Toll-like receptor (TLR)-7/8 agonist, which stimulates the innate cutaneous immunity and the cellular arm of the adaptive immune response, and has potent anti-viral, anti-tumor, and immunoregulatory effects 3.
- Cantharidin: a topical treatment that has been shown to be effective in treating molluscum contagiosum, with variable clearance rates ranging from 15.4-100% 4, 5.
- Combination therapy: cantharidin and imiquimod 5% can be used in combination to treat molluscum contagiosum, with effective and well-tolerated results in pediatric patients 6.
Safety and Efficacy
- Topical imiquimod has been shown to be safe and effective in treating molluscum contagiosum in children, with mild to moderate irritation in the application area being the only cutaneous adverse reaction observed 3.
- Topical cantharidin has been shown to be well-tolerated and associated with the resolution of molluscum contagiosum, with no serious adverse events or side effects observed 4, 5.
- Combination therapy with cantharidin and imiquimod 5% has been shown to be effective and well-tolerated in children with molluscum contagiosum, with one patient finding the cantharidin reaction too strong 6.