What is a cheap and effective treatment for a child with Molluscum contagiosum (a viral skin infection) presenting with increasing lesions under the jaw and neck?

From the Guidelines

For a child with Molluscum contagiosum under the jaw and neck with increasing lesions, I recommend 10% potassium hydroxide as a cheap and effective treatment option. According to a study published in Pediatrics in 2017 1, 10% potassium hydroxide and cryotherapy with liquid nitrogen have been used to treat lesions that occur in locations that are cosmetically bothersome to patients. The study suggests that both forms of treatment appear to have similar efficacy in children.

Some key points to consider when using 10% potassium hydroxide include:

• Apply a small amount directly to each lesion with a cotton swab once daily, being careful to avoid surrounding healthy skin
• Continue treatment for 2-4 weeks until lesions resolve
• Prevent spread by avoiding scratching, covering lesions with bandages when possible, using separate towels, and avoiding sharing personal items
• Monitor for signs of bacterial infection, such as redness, pain, or increased swelling, and consult a healthcare provider if lesions do not improve after 4 weeks of home treatment

It's also important to note that resolution of uncomplicated molluscum contagiosum typically occurs spontaneously in 6 to 12 months, although complete resolution of lesions can take up to 4 years 1. However, treatment can speed healing and prevent spread to other body areas or family members. Other treatment options, such as cryotherapy and cantharidin, may also be effective, but 10% potassium hydroxide is a cheap and effective option that can be used as a first-line treatment.

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). Complete clearance (no MC lesions) was assessed at Week 18 In Study 1, the complete clearance rate was 24% (52/217) in the imiquimod cream group compared with 26% (28/106) in the vehicle group. In Study 2, the clearance rates were 24% (60/253) in the imiquimod cream group compared with 28% (35/126) in the vehicle group. These studies failed to demonstrate efficacy

The imiquimod cream may not be an effective treatment for molluscum contagiosum in children, as the studies failed to demonstrate efficacy.

• The complete clearance rates were similar between the imiquimod cream group and the vehicle group in both studies.
• The most frequently reported adverse reaction was application site reaction.
• Other adverse events included otitis media and conjunctivitis.
• Severe local skin reactions reported by treated subjects included erythema, edema, scabbing/crusting, flaking/scaling, erosion, and weeping/exudate 2.

From the Research

Treatment Options for Molluscum Contagiosum

• Several treatment options exist for molluscum contagiosum, including topical treatments and mechanical methods such as cryotherapy and curettage 3.
• The choice of treatment depends on the number and location of lesions, as well as the preferences of the child's parents or carers 3.

Topical Treatments

• 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 4.
• Imiquimod is a painless and cosmetically accepted treatment, making it a preferred option for children with numerous small lesions 5.
• Other topical treatments, such as podophyllotoxin, sodium nitrite, and salicylic acid, have also been shown to be effective in treating molluscum contagiosum 6.

Comparison of Treatments

• A comparative study found that imiquimod 5% cream was as effective as cryotherapy in treating molluscum contagiosum in children, but with fewer side effects such as pain and scarring 5.
• Cryotherapy has the advantage of being rapidly effective, but may be more expensive than imiquimod and may not be suitable for children with numerous small lesions 5.

Considerations for Treatment

• The decision to intervene should be a joint decision among the child, parents/guardians, and the practitioner, taking into account the reduction of symptoms, spread, and disease remission 7.
• The treatment of molluscum contagiosum should be individualized, considering the number and location of lesions, as well as the child's overall health and preferences 3.