What are the treatment options for Molluscum contagiosum?

Treatment Options for Molluscum Contagiosum

Molluscum contagiosum is a benign viral skin infection that typically resolves spontaneously within 6 to 12 months, although complete resolution can take up to 4 years in some cases 1. Despite its self-limiting nature, treatment may be warranted in certain situations.

When to Consider Treatment

Treatment should be considered in the following scenarios:

• Lesions in cosmetically bothersome locations
• Patients with underlying skin conditions such as eczema
• Symptomatic lesions (pain, itching, redness)
• Risk of bacterial superinfection
• To reduce transmissibility, especially in athletes or school settings
• Large or multiple lesions with minimal inflammation in adults (may indicate immunocompromised state)

First-Line Treatment Options

For symptomatic patients requiring intervention, the following options are recommended:

1. Physical removal methods:
   • Incision and curettage (aggressive enough to cause bleeding)
   • Simple excision
   • Excision and cautery
   • Cryotherapy with liquid nitrogen

These methods are particularly indicated when prompt removal is desired 1. However, cryotherapy may be associated with postinflammatory hyperpigmentation or, uncommonly, scarring 1.

1. Topical treatments:
   • 10% potassium hydroxide solution - similar efficacy to cryotherapy in children but with less risk of scarring 1

Second-Line Treatment Options

• Cantharidin: Open-label and observational studies indicate effectiveness, though a small randomized controlled trial of 29 patients showed improvement that was not statistically significant compared to placebo 1

Ineffective Treatments

• Imiquimod: Not shown to be of benefit compared with placebo in randomized controlled trials 1

Special Considerations

1. Ocular involvement:

   • When molluscum lesions on eyelids cause conjunctivitis or keratitis due to viral shedding, removal of the lesions is indicated 1
   • The conjunctivitis may require weeks to resolve after elimination of the lesion 1

2. Multiple lesions:

   • Care should be taken to identify and treat nascent lesions to reduce recurrence risk
   • Reduction of viral load often allows the host immune response to eliminate residual virus 1

3. Immunocompromised patients:

   • May have more persistent lesions requiring more aggressive treatment
   • Large and multiple lesions with relatively little inflammation may indicate an immunocompromised state 1

Follow-Up Recommendations

• Follow-up is not usually necessary unless conjunctivitis persists or new lesions develop
• Referral to a dermatologist may be necessary for examination of other suspicious lesions 1

Important Caveats

• Treatment is optional in most immunocompetent individuals since spontaneous resolution occurs
• The choice of treatment should consider the patient's age, number and location of lesions, and presence of symptoms
• Avoid aggressive treatments in children that may cause significant pain or distress
• In athletes, especially wrestlers, covering lesions may be required before return to competition 1