What is the treatment for Molluscum contagiosum using cream?

Treatment Options for Molluscum Contagiosum Using Topical Preparations

For molluscum contagiosum, 10% potassium hydroxide (KOH) solution and cryotherapy with liquid nitrogen are the most effective topical treatments, particularly for lesions that are cosmetically bothersome or in patients with underlying skin conditions like eczema. 1

Understanding Molluscum Contagiosum

Molluscum contagiosum is a common, benign viral skin infection characterized by:

• Skin-colored papules with central umbilication
• Affects 5-11% of children aged 0-16 years
• Commonly appears on trunk, face, and extremities
• Usually asymptomatic but may cause pain, itching, redness, or bacterial superinfection

Natural Course and Treatment Decision

• Spontaneous resolution typically occurs in 6-12 months
• Complete resolution may take up to 4 years
• Treatment is indicated when:
  • Lesions are cosmetically bothersome
  • Patient has underlying skin conditions like eczema
  • Lesions are causing symptoms
  • Concerns about transmission exist

First-Line Topical Treatment Options

10% Potassium Hydroxide (KOH) Solution

• Similar efficacy to cryotherapy in children 1
• Demonstrated significant reduction in lesion count over 12 weeks 2
• Application: 3 times per week until lesions clear
• Advantages: Can be applied at home, less painful than some alternatives

Cryotherapy with Liquid Nitrogen

• Similar efficacy to KOH 1
• Caution: May cause postinflammatory hyperpigmentation or scarring (uncommon) 1
• Better suited for older children and adults who can tolerate the procedure

Other Treatment Options

Cantharidin

• Open-label studies show effectiveness 1
• However, in a small randomized controlled trial (29 patients), improvement was not statistically significant compared to placebo 1

Imiquimod

• Important note: Randomized controlled trials showed imiquimod was not superior to placebo 1
• Some smaller studies suggest partial efficacy:
  • 69% response rate in an open-label trial with children 3
  • 66.7% partial clearance at 12 weeks in a small pilot study 4
• However, these findings are contradicted by higher quality evidence

Physical Removal Methods

• Incision and curettage (aggressive enough to cause bleeding)
• Simple excision
• Excision and cautery
• Cryotherapy 1

Treatment Algorithm

1. For asymptomatic lesions in immunocompetent patients:

   • Consider watchful waiting (spontaneous resolution in 6-12 months)

2. For symptomatic lesions or cosmetically bothersome areas:

   • First-line: 10% KOH solution applied 3 times weekly
   • Alternative: Cryotherapy with liquid nitrogen (especially for older patients)

3. For patients with multiple lesions:

   • Identify and treat all lesions including nascent ones
   • Reduction of viral load often allows host immune response to eliminate residual virus 1

4. For eyelid lesions causing conjunctivitis:

   • Treatment options include incision and curettage, simple excision, excision and cautery, or cryotherapy
   • Conjunctivitis may require weeks to resolve after elimination of the lesion 1

Special Considerations

• In adults, large and multiple molluscum lesions with relatively little inflammation may indicate an immunocompromised state 1
• Follow-up is not usually necessary unless conjunctivitis or other symptoms persist
• Dermatology referral may be necessary for examination of other suspicious lesions 1

Common Pitfalls to Avoid

1. Using imiquimod as first-line therapy despite evidence showing lack of benefit compared to placebo in randomized controlled trials
2. Failing to identify and treat all lesions, leading to recurrence
3. Overlooking the possibility of an immunocompromised state in adults with extensive lesions
4. Using cryotherapy in areas prone to scarring or hyperpigmentation, especially in patients with darker skin tones