From the Guidelines
The first-line treatment for a patient with molluscum contagiosum and eczema should prioritize gentle management to avoid exacerbating the eczema, with options including watchful waiting, 10% potassium hydroxide, or cryotherapy with liquid nitrogen for cosmetically bothersome lesions. When considering treatment, it's essential to weigh the potential benefits against the risks of worsening eczema or causing postinflammatory hyperpigmentation, as noted in studies such as 1. Key considerations include:
- The natural history of molluscum contagiosum, which typically resolves spontaneously in 6 to 12 months, although this can take up to 4 years 1.
- The potential for treatments like cryotherapy to cause postinflammatory hyperpigmentation or scarring, albeit uncommonly 1.
- The importance of managing eczema to prevent flare-ups that could be triggered by the treatment of molluscum contagiosum, suggesting the use of topical corticosteroids and moisturizers to maintain skin barrier function.
- The lack of strong evidence supporting the use of imiquimod for molluscum contagiosum, as it was not shown to be of benefit compared with placebo in randomized controlled trials 1.
- The potential effectiveness of cantharidin, as indicated by open-label and observational studies, although its efficacy was not found to be statistically significant in a small randomized controlled trial 1.
From the Research
Treatment Options for Molluscum Contagiosum with Eczema
- The first line treatment for a patient with molluscum contagiosum and eczema is cantharidin, as discussed in the study 2.
- Cantharidin is a destructive therapy that is effective in treating molluscum contagiosum, with a study showing that 90% of patients experienced clearing and 8% improved with cantharidin therapy 3.
- Another study confirmed the safety and efficacy of topical cantharidin for the treatment of pediatric molluscum contagiosum, with 36.2% of participants in the combined cantharidin arms achieving clearance compared to 10.6% in the placebo arms 4.
- It is worth noting that eczema molluscatum, which describes the occurrence of molluscum contagiosum virus infection in a patient with underlying atopic dermatitis, has been observed in patients treated with topical immunomodulators such as tacrolimus 5.
- The use of cantharidin is supported by its high efficacy and low risk of side effects, making it a suitable treatment option for patients with molluscum contagiosum and eczema 2, 4, 3.
Considerations for Treatment
- The treatment of molluscum contagiosum in patients with eczema should take into account the potential for spread and the risk of superinfection 2.
- The use of topical cantharidin has been shown to be well-tolerated and effective in treating molluscum contagiosum in pediatric patients, including those with eczema 4, 3.
- It is essential to consider the individual patient's needs and medical history when selecting a treatment option for molluscum contagiosum with eczema 2, 5.