What is the gold standard treatment for Molluscum contagiosum?

From the Guidelines

The most effective treatment for molluscum contagiosum is cryotherapy with liquid nitrogen, as it has similar efficacy to other treatments with minimal side effects, as shown in a study published in Pediatrics in 2017 1. When considering treatment options, it's essential to weigh the benefits and risks of each approach.

• Cryotherapy with liquid nitrogen is a commonly used treatment, applied every 2-3 weeks until resolution, with similar efficacy to other treatments such as 10% potassium hydroxide and cantharidin.
• Cantharidin, a blistering agent, has shown promise in open-label and observational studies, but its efficacy was not statistically significant in a small randomized controlled trial 1.
• Imiquimod was not found to be beneficial compared to placebo in randomized controlled trials 1.
• Treatment choice depends on patient age, lesion location and number, pain tolerance, and provider expertise.
• The goal of treatment is to eliminate visible lesions, prevent autoinoculation, and reduce transmission to others by destroying the virus-containing core of the lesions. A more recent study published in Ophthalmology in 2024 2 highlights the importance of treating symptomatic patients and removing lesions to prevent conjunctivitis and keratitis.
• Incision and curettage, simple excision, excision and cautery, and cryotherapy are all viable treatment options for molluscum contagiosum lesions.
• Reduction of the viral load often allows the host immunologic response to eliminate residual virus, and follow-up is not usually necessary unless the conjunctivitis persists. In summary, cryotherapy with liquid nitrogen is a safe and effective treatment option for molluscum contagiosum, with minimal side effects, making it a preferred choice for many patients 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 gold standard treatment for MOLLUSCUM CONTAGIOSUM is not specified in the provided drug labels.

• The studies mentioned in the labels failed to demonstrate efficacy of imiquimod cream in treating molluscum contagiosum in pediatric patients 3, 4.
• The labels do not provide information on the gold standard treatment for molluscum contagiosum 5.

From the Research

Molluscum Contagiosum Treatment

The treatment of molluscum contagiosum (MC) is controversial, and there is no single gold standard treatment.

• Various treatment modalities are available, including mechanical, chemical, immunomodulatory, and antiviral treatments 6.
• Treatment options may be considered in cases of extensive disease, associated complications, or aesthetic complaints 6.

Treatment Options

Some of the treatment options for MC include:

• Cantharidin, which is a first-line treatment approach for those needing treatment 7.
• Imiquimod 5% cream, which has been shown to be effective and well-tolerated in children 8, 9.
• Cryotherapy, which is rapidly effective but may be associated with pain, bullae formation, and pigmentary changes 9.
• Combination therapy using cantharidin and imiquimod, which has been shown to be effective in clearing lesions in children 8.

Comparison of Treatment Options

A comparative study found that imiquimod 5% cream and cryotherapy had similar overall complete cure rates, but imiquimod was associated with fewer side effects and was more cosmetically accepted 9.

• Imiquimod may be preferred for treating numerous small lesions, while cryotherapy may be preferred for large solitary or few lesions 9.