What are the differences in treatment for Molluscum contagiosum vs Hand, Foot, and Mouth Disease (HFMD)?

Treatment Differences Between Molluscum Contagiosum and Hand, Foot, and Mouth Disease

Molluscum contagiosum and Hand, Foot, and Mouth Disease (HFMD) require completely different treatment approaches, with molluscum typically requiring physical or chemical destruction of lesions while HFMD is managed with supportive care only as it resolves spontaneously within 7-10 days.

Molluscum Contagiosum Treatment

Overview

• Viral skin infection caused by Molluscipox virus
• Presents as flesh-colored, dome-shaped papules with central umbilication
• Can persist for months to years (6-12 months typically, up to 4 years)

Treatment Recommendations

1. Observation (watchful waiting)

   • Appropriate for asymptomatic, limited lesions in immunocompetent patients
   • Monitor for 3-6 months for spontaneous resolution 1

2. First-line active treatments (for bothersome, extensive, or symptomatic lesions):

   • Cantharidin application: Well-tolerated and effective, especially for children 1
   • 10% Potassium hydroxide: Comparable efficacy to cryotherapy (86.6% complete response) 1
   • Cryotherapy with liquid nitrogen: Highly effective (93.3% complete response) but may cause hyperpigmentation or scarring 1, 2

3. Second-line treatments:

   • Curettage: Effective for immediate removal but potentially painful 1, 2
   • Excision: For isolated, larger lesions 2
   • Topical acids/treatments: Salicylic acid, lactic acid, tretinoin 2

4. Not recommended:

   • Imiquimod: Not more effective than placebo in randomized controlled trials 1, 3

Special Considerations

• Ocular involvement: Requires prompt treatment to prevent conjunctivitis 1
• Immunocompromised patients: More aggressive treatment approach needed 1
• Athletes in contact sports: More aggressive treatment to prevent transmission 1

Hand, Foot, and Mouth Disease (HFMD) Treatment

Overview

• Viral infection caused by enteroviruses (primarily Coxsackievirus A16 and Enterovirus 71)
• Self-limiting illness that typically resolves within 7-10 days
• Presents with fever, oral ulcers, and vesicular rash on hands, feet, and sometimes buttocks

Treatment Recommendations

1. Supportive care only - No specific antiviral treatment is indicated

   • Adequate fluid intake to prevent dehydration
   • Pain management with acetaminophen or ibuprofen for fever and discomfort
   • Topical oral anesthetics for mouth pain (if needed)
   • Cold liquids, ice pops, and soft foods for oral discomfort

2. No role for antiviral medications, antibiotics, or destructive therapies

3. Isolation precautions:

   • Avoid close contact during acute illness
   • Hand hygiene and respiratory etiquette
   • Disinfection of contaminated surfaces

Key Differences in Treatment Approach

Aspect	Molluscum Contagiosum	Hand, Foot, and Mouth Disease
Duration	Chronic (months to years)	Acute (7-10 days)
Treatment goal	Lesion removal/destruction	Symptom relief only
Primary approach	Active treatment often recommended	Supportive care only
Specific therapies	Physical destruction (cryotherapy, curettage) or chemical treatments (cantharidin, KOH)	None - symptomatic treatment only
Medication use	Topical treatments	Only for symptom relief (antipyretics, analgesics)
Follow-up needs	May require multiple treatments	Usually none needed

Prevention Strategies

Molluscum Contagiosum

• Avoid touching or scratching lesions
• Avoid sharing personal items (towels, clothing)
• Cover lesions during contact sports
• Avoid swimming pools until lesions resolve 1, 4

Hand, Foot, and Mouth Disease

• Hand hygiene
• Respiratory etiquette
• Disinfection of surfaces
• Temporary exclusion from school/daycare during acute illness

Remember that while molluscum contagiosum often requires intervention to prevent spread and autoinoculation, HFMD is managed conservatively with supportive care as it resolves spontaneously within days.