What are the treatment options for molluscum contagiosum?

Treatment Options for Molluscum Contagiosum

The most effective first-line treatment for bothersome molluscum contagiosum is cryotherapy with liquid nitrogen, which has a 93.3% complete response rate, or cantharidin application which is well-tolerated and effective, particularly in children. 1

Treatment Algorithm

First-Line Options:

1. For asymptomatic, limited lesions in immunocompetent patients:

   • Observation for spontaneous resolution with monitoring for 3-6 months 1
   • Cover visible lesions with clothing/bandages to prevent spread

2. For bothersome, extensive, or symptomatic lesions:

   • Cryotherapy with liquid nitrogen - applied every 1-2 weeks until lesions resolve 1
   • Cantharidin application - well-tolerated, especially in children 1, 2
   • 10% potassium hydroxide - comparable efficacy to cryotherapy (86.6% complete response) 1

Second-Line Options:

• Surgical options:

  • Curettage or excision
  • Tangential scissor excision
  • Shave excision
  • Electrosurgery (for larger lesions) 1

• Chemical treatments:

  • Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80%-90% - apply until white "frosting" develops 1
  • Podophyllin resin 10%-25% in compound tincture of benzoin 1

Important Considerations

Efficacy of Treatments

Treatment	Efficacy	Potential Complications
Cryotherapy	93.3% complete response	Pain, necrosis, blistering, hyperpigmentation
Cantharidin	High efficacy	Minimal side effects
10% KOH	86.6% complete response	Mild irritation

Special Populations

Children:

• Avoid painful treatments in young children when possible 1
• Cantharidin is particularly well-tolerated in children 2
• Important note: Imiquimod is NOT recommended as randomized controlled trials have shown it is not more effective than placebo 1 and FDA labeling confirms this lack of efficacy in pediatric studies 3

Near-Eye Lesions:

• Prompt treatment is recommended to prevent conjunctivitis 1

Immunocompromised Patients:

• Evaluation for immunocompromised state should be considered in adults with large and multiple lesions 1

Prevention of Spread

• Cover visible lesions with clothing or bandages
• Maintain good hand hygiene, especially after touching lesions
• Avoid sharing personal items like towels and clothing
• Avoid scratching or picking at lesions to prevent autoinoculation 1

Common Pitfalls to Avoid

1. Using imiquimod as treatment - Despite its common use, clinical studies have demonstrated it is not more effective than placebo for molluscum contagiosum 1, 3

2. Failing to identify and treat nascent lesions - This increases recurrence risk 1

3. Overlooking associated conditions - Patients with atopic dermatitis may develop more widespread involvement 4

4. Ignoring prevention measures - Essential to provide guidance on preventing spread through avoiding touching lesions and intimate contact until resolution 1

5. Using painful treatments in young children - Can cause unnecessary trauma when less painful options are available 1

The recent FDA approval of YCANTH™ (cantharidin 0.7%) topical solution provides a standardized formulation for treating molluscum contagiosum in children (≥2 years) and adults, with demonstrated efficacy in phase-3 trials 5.