From the Guidelines
Treatment for Molluscum contagiosum in a primary care setting should prioritize watchful waiting, given its self-limiting nature, with active intervention reserved for cosmetically bothersome lesions or those in patients with underlying skin conditions. The management of Molluscum contagiosum typically involves observation, as resolution of uncomplicated cases usually occurs spontaneously within 6 to 12 months, although complete resolution can take up to 4 years 1. When active treatment is deemed necessary, options such as 10% potassium hydroxide and cryotherapy with liquid nitrogen have been used, with both appearing to have similar efficacy in children, though cryotherapy may be associated with postinflammatory hyperpigmentation or scarring 1. Key considerations for treatment choice include:
- Patient age
- Number and location of lesions
- Presence of underlying skin conditions
- Patient or parent preference Some treatments, like imiquimod, have not shown significant benefit compared to placebo in randomized controlled trials 1, while others, such as cantharidin, have shown promise in open-label and observational studies but lack strong evidence from randomized controlled trials 1. Given the current evidence, cryotherapy with liquid nitrogen and 10% potassium hydroxide are reasonable first-line treatment options for Molluscum contagiosum in a primary care setting, especially for lesions that are cosmetically bothersome or in patients with underlying skin conditions. It is essential to advise patients on preventive measures to avoid spreading the infection, such as avoiding shared use of towels, clothing, or direct skin contact with lesions, and covering lesions when possible.
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 most frequently reported adverse reaction from 2 studies in children with molluscum contagiosum was application site reaction
The treatment options for Molluscum contagiosum in a primary care setting are not established for imiquimod cream, as the studies failed to demonstrate efficacy 2. Application site reactions are common adverse effects.
From the Research
Treatment Options for Molluscum Contagiosum
- The treatment of molluscum contagiosum can be challenging, especially in cases with multiple lesions or in pediatric patients 3, 4, 5.
- Various treatment options are available, including:
- Pulsed dye laser therapy, which has been shown to be effective in treating molluscum contagiosum with minimal side effects 3, 4, 5.
- Cantharidin, a topical treatment that can be used to treat molluscum contagiosum, especially in cases where other treatments are not effective or practical 6.
- Curettage, cryotherapy, and other destructive therapies, which can be used to remove lesions but may require multiple sessions and can be painful 6, 7.
- Immunomodulators and antivirals, which can be used to treat molluscum contagiosum, especially in cases with underlying immune system disorders or other complications 6, 7.
Considerations for Treatment
- The choice of treatment for molluscum contagiosum depends on various factors, including the number and location of lesions, the patient's age and overall health, and the presence of any underlying conditions 6, 7.
- Treatment should be individualized to each patient's needs and circumstances, and may involve a combination of different therapies 7.
- It is essential to consider the potential risks and benefits of each treatment option, as well as the patient's preferences and values, when making treatment decisions 7.
Efficacy of Pulsed Dye Laser Therapy
- Pulsed dye laser therapy has been shown to be effective in treating molluscum contagiosum, with high clearance rates and minimal side effects 3, 4, 5.
- The use of pulsed dye laser therapy can reduce the need for multiple treatments and minimize the risk of complications, such as scarring and infection 3, 4, 5.
- The efficacy of pulsed dye laser therapy for molluscum contagiosum has been demonstrated in several studies, including a study that reported a 96.3% clearance rate after a single treatment session 3.