From the Guidelines
Treatment to remove molluscum contagiosum lesions is indicated in symptomatic patients, with options including incision and curettage, simple excision, excision and cautery, and cryotherapy. The management of molluscum contagiosum should prioritize reducing the viral load to allow the host immunologic response to eliminate residual virus 1.
Key Considerations
- Molluscum lesions may spontaneously resolve, but they can also persist for months to years, and treatment is necessary for symptomatic patients.
- In patients with multiple lesions, care should be taken to identify and treat nascent lesions to reduce the risk of recurrence.
- The conjunctivitis associated with molluscum contagiosum may require weeks to resolve after elimination of the lesion.
- Adults with large and multiple molluscum lesions and relatively little conjunctival inflammation may indicate an immunocompromised state, and referral to a dermatologist may be necessary for examination of other suspicious lesions 1.
Treatment Options
- Incision and curettage: an aggressive method that can cause bleeding, but effective in removing lesions.
- Simple excision: a surgical method that involves removing the lesion.
- Excision and cautery: a method that combines surgical removal with cauterization to reduce bleeding.
- Cryotherapy: a method that uses liquid nitrogen to freeze the lesion, causing it to fall off. It is essential to note that while other treatments like cantharidin and imiquimod have been studied, the most recent and highest quality evidence supports the use of physical destruction methods like those mentioned above 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 Similar to the studies conducted in adults, the most frequently reported adverse reaction from 2 studies in children with molluscum contagiosum was application site reaction
The management of molluscum contagiosum using imiquimod cream is not recommended as the studies failed to demonstrate efficacy 2.
- The most common adverse reaction was application site reaction.
- Imiquimod cream is not indicated for the treatment of molluscum contagiosum 2.
From the Research
Management of Molluscum
The management of molluscum contagiosum is a topic of ongoing debate, with various treatment options available. Some of the key considerations include:
- The disease is generally self-limited, with lesions resolving on their own within 6-9 months 3
- However, treatment may be indicated in cases of extensive disease, associated complications, or aesthetic concerns 3, 4
- Treatment options include mechanical, chemical, immunomodulatory, and antiviral therapies 3, 5
Treatment Options
Some of the treatment options for molluscum contagiosum include:
- Cantharidin, a topical treatment that can be effective in treating lesions 5
- Imiquimod, a topical cream that has been shown to be effective in treating molluscum contagiosum in children 6, 7
- Cryotherapy, curettage, and other destructive therapies may also be used to treat lesions 5
- Immunomodulators, such as cimetidine, and antivirals, such as cidofovir, may also be used in some cases 5
Considerations for Treatment
When considering treatment for molluscum contagiosum, some factors to keep in mind include:
- The risk of scarring and superinfection, particularly in immunocompromised individuals 4
- The potential for autoinoculation and transmission to others 4
- The importance of early diagnosis and treatment to reduce the risk of complications and improve patient quality of life 4
- The need for individualized treatment approaches, taking into account the patient's age, immune status, and other factors 6