What are the treatment options for molluscum contagiosum?

From the Guidelines

Treatment for molluscum contagiosum should prioritize removal of lesions in symptomatic patients, with options including incision and curettage, simple excision, excision and cautery, and cryotherapy, as these methods have been shown to be effective in reducing the risk of recurrence and allowing the host immunologic response to eliminate residual virus 1.

Treatment Options

The following treatment options are available for molluscum contagiosum:

• Incision and curettage: a procedure that involves removing the lesion with a curette, which can be aggressive enough to cause bleeding
• Simple excision: a procedure that involves surgically removing the lesion
• Excision and cautery: a procedure that involves surgically removing the lesion and using cautery to prevent bleeding
• Cryotherapy: a procedure that involves freezing the lesion with liquid nitrogen In patients with multiple lesions, it is essential to identify and treat nascent lesions to reduce the risk of recurrence 1.

Considerations

When treating molluscum contagiosum, it is crucial to consider the following factors:

• Patient age: treatment options may vary depending on the patient's age
• Lesion number and location: treatment options may vary depending on the number and location of lesions
• Pain tolerance: treatment options may vary depending on the patient's pain tolerance Multiple treatment sessions may be needed, spaced 2-3 weeks apart, to ensure complete removal of the lesions 1.

Prevention

To prevent the spread of molluscum contagiosum, patients should:

• Avoid scratching lesions
• Avoid sharing personal items
• Inform sexual partners if lesions are in genital areas By prioritizing the removal of lesions and taking preventive measures, patients can reduce the risk of recurrence and promote effective treatment of 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

The treatment options for molluscum contagiosum using imiquimod cream are not supported by the FDA drug label, as the studies failed to demonstrate efficacy 2, 2.

• Key points:
  • Imiquimod cream was evaluated in two randomized trials.
  • The trials involved 702 pediatric subjects with molluscum contagiosum.
  • The studies did not show a significant effect of imiquimod cream on molluscum contagiosum.
  • Imiquimod cream is not recommended for the treatment of molluscum contagiosum based on the available data 2.

From the Research

Treatment Options for Molluscum Contagiosum

• Destructive therapies:
  • Curettage 3, 4, 5, 6
  • Cryotherapy 3, 4, 5, 6
  • Cantharidin 3, 4, 5, 6
  • Keratolytics 5
• Topical medical therapy:
  • Salicylic acid 4
  • Glycolic acid 4
  • Tretinoin 4
  • Tazortene 4
  • 5 percent sodium nitrite co-applied daily with 5 percent salicylic acid topical preparations 4
  • Podofilox 4
  • Liquefied phenol 4
  • Cantharidin 4, 5
  • Potassium hydroxide 4
  • Adapelene 4
• Oral therapy:
  • Cimetidine 4, 7
• Immunomodulators:
  • Imiquimod 5, 6
  • Cimetidine 5
  • Candida antigen 5
• Antivirals:
  • Cidofovir 5
• Watchful waiting: may be an appropriate management strategy for some patients 5

Special Considerations

• Atopic dermatitis: patients with atopic dermatitis may develop widespread involvement with molluscum contagiosum 3, 4, 5
• Skin of color: special considerations may be necessary when treating molluscum contagiosum in patients with skin of color 3
• Pediatric patients: treatment options may need to be tailored to the individual child's needs and circumstances 3, 4, 5, 7