What are the treatment options for molluscum contagiosum?

From the Guidelines

Treatment for molluscum contagiosum should prioritize watchful waiting for uncomplicated cases, given that resolution typically occurs spontaneously in 6 to 12 months, although active interventions like cryotherapy with liquid nitrogen or cantharidin may be considered for cosmetically bothersome lesions or in patients with underlying skin conditions. When considering treatment options, it's essential to weigh the potential benefits against the risks, especially in children, where the condition often resolves on its own. The choice between watchful waiting and active treatment depends on factors such as patient age, the number and location of lesions, and patient preference. Some key points to consider in the management of molluscum contagiosum include:

• Observation is a reasonable approach for children with limited lesions, given the high rate of spontaneous resolution 1.
• Active treatments like cryotherapy with liquid nitrogen and cantharidin have shown efficacy, although they may be associated with side effects such as postinflammatory hyperpigmentation or scarring 1.
• Topical treatments, including potassium hydroxide, may also be effective but should be used with caution due to potential side effects.
• Imiquimod has not been shown to be beneficial in randomized controlled trials 1. In terms of specific treatment recommendations, cryotherapy with liquid nitrogen applied for 5-10 seconds per lesion is a commonly used method for treating molluscum contagiosum, especially for lesions that are cosmetically bothersome or in patients with underlying skin conditions. However, the most recent and highest quality evidence should always guide treatment decisions, and in the context of molluscum contagiosum, the approach may vary based on the latest research findings 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). 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 treatment options for molluscum contagiosum include imiquimod cream, although the studies failed to demonstrate its efficacy in pediatric subjects.

• 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. 2

From the Research

Treatment Options for Molluscum Contagiosum

The treatment options for molluscum contagiosum include:

• Physician-administered therapies 3
• Patient-administered therapies 3
• Destructive therapies, such as:
  • Curettage 4, 5
  • Cryotherapy 4, 6, 5
  • Cantharidin 4, 5
  • Keratolytics 4
• Immunomodulators, such as:
  • Imiquimod 4
  • Cimetidine 4
  • Candida antigen 4
• Antivirals, such as:
  • Cidofovir 4
• Topical therapies, such as:
  • Retinoic acid 7
  • Potassium hydroxide 5
  • Salicylic acid 5
  • Hydrogen peroxide 5
  • Retinoids 5
• Laser therapy, such as:
  • Pulsed dye laser 6, 5

Considerations for Treatment

Treatment options may be chosen based on factors such as:

• Patient preference 3
• Lesion location and number 4
• Presence of symptoms, such as discomfort or itching 4
• Risk of scarring or superinfection 4
• Social stigma associated with visible lesions 4
• Patient age and immune status 3, 4