What topical cream can a patient apply themselves for molluscum contagiosum?

Topical Treatment Options for Molluscum Contagiosum

For patients seeking a self-applied topical treatment for molluscum contagiosum, 10% potassium hydroxide (KOH) solution is the most effective first-line option with an 86.6% complete response rate. 1

First-Line Treatment Options

10% Potassium Hydroxide (KOH) Solution

• Highly effective with comparable efficacy to professional cryotherapy (86.6% complete response rate)
• Can be safely self-applied by patients
• Apply 3 times per week until lesions clear
• Well-tolerated with minimal side effects
• Studies show statistically significant reduction in lesion counts (p<0.005) 2

Alternative Options

Imiquimod 5% Cream

• Not recommended as first-line therapy as:
  • FDA studies show it failed to demonstrate efficacy in children with molluscum contagiosum 3
  • Randomized controlled trials show it is not more effective than placebo according to Pediatrics journal 1
  • May cause significant local side effects including erythema (85%), itching (75%), burning sensations (23%), and pain (11%) 4
  • Some smaller studies show variable response rates (69% in one small open-label trial) 4

Cantharidin

• Available only through physician application
• Well-tolerated and effective when professionally applied
• Not suitable for self-application by patients

Application Instructions for 10% KOH

1. Apply a thin layer to lesions using a cotton-tipped applicator
2. Apply 3 times per week
3. Continue until lesions clear (typically within 4-12 weeks)
4. Avoid application to healthy skin
5. Discontinue if severe irritation develops

Prevention of Spread

While undergoing treatment, patients should:

• Cover visible lesions with clothing or bandages when possible
• 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

Special Considerations

• For extensive or treatment-resistant cases, consider professional treatment with cryotherapy (93.3% complete response rate) 1
• For lesions near the eyes, prompt professional treatment is recommended to prevent conjunctivitis 1
• Multiple lesions require identification and treatment of nascent lesions to reduce recurrence risk 1
• Consider evaluation for immunocompromised state in adults with large and multiple lesions 1

Treatment Algorithm

1. First attempt: 10% KOH solution applied 3 times weekly for 4-12 weeks
2. If ineffective after 4 weeks or intolerable: Seek professional treatment with cryotherapy
3. For extensive disease or special locations (near eyes, genitals): Professional medical evaluation is recommended

While imiquimod has been studied and used for molluscum contagiosum, its efficacy is questionable based on FDA-approved studies, and it carries a higher risk of side effects and significantly higher cost compared to KOH solution.