What are the treatment options for symptomatic management of Molluscum contagiosum?

Symptomatic Management of Molluscum Contagiosum

For symptomatic management of molluscum contagiosum, physical removal of lesions through methods such as incision and curettage, simple excision, excision and cautery, or cryotherapy is the recommended first-line treatment approach. 1

Understanding Molluscum Contagiosum

Molluscum contagiosum is a common viral skin infection characterized by:

• Dome-shaped, skin-colored papules with central umbilication
• Affects 5-11% of children aged 0-16 years 1
• Can persist for months to years (typically 6-12 months, but up to 4 years) 1
• May present with pain, itching, redness, or bacterial superinfection 1
• Can cause conjunctivitis and keratitis when lesions are on the eyelids 1

Treatment Algorithm for Symptomatic Management

First-Line Treatments:

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

Second-Line Treatments:

1. Chemical treatments:
   • 10% potassium hydroxide solution 1
   • Cantharidin (the only FDA-approved treatment as of 2023) 2

Treatment Selection Considerations:

• Number of lesions: For multiple lesions, identify and treat nascent lesions to reduce recurrence risk 1
• Location: Eyelid lesions require removal to prevent conjunctivitis/keratitis 1
• Patient age: Children may tolerate certain procedures better than others
• Immune status: Immunocompromised patients may require more aggressive treatment 1

Special Considerations

Eyelid Lesions

• Removal of eyelid lesions is particularly important as viral shedding can cause conjunctivitis and keratitis 1
• Conjunctivitis may take weeks to resolve after lesion removal 1
• Follow-up is necessary if conjunctivitis persists 1

Immunocompromised Patients

• Large and multiple lesions with minimal inflammation may indicate immunocompromised state 1
• More aggressive treatment approaches may be needed 1
• Consider dermatology referral for comprehensive management 1

Children with Atopic Dermatitis

• Children with underlying skin conditions like eczema may benefit from treatment to prevent spread and exacerbation 3
• Consider gentler treatment options to avoid skin irritation

Treatment Efficacy and Limitations

• No single treatment is uniformly effective 3
• Cryotherapy may cause postinflammatory hyperpigmentation or scarring, particularly in children 1
• Imiquimod has not shown benefit compared to placebo in randomized controlled trials 1
• Cantharidin shows promise in observational studies but has limited evidence from randomized trials 1

Clinical Pearls

• Reduction of viral load often allows the host immune response to eliminate residual virus 1
• Treatment is indicated for symptomatic patients to alleviate discomfort, limit spread, prevent scarring/superinfection, and eliminate social stigma 3
• Watchful waiting can be appropriate in asymptomatic cases, as spontaneous resolution eventually occurs 1, 4
• For patients with multiple lesions, treat all visible lesions to prevent autoinoculation 1
• Dermatology referral may be necessary for extensive disease or treatment-resistant cases 1