From the Guidelines
Treatment of Molluscum contagiosum should prioritize removal of lesions through methods such as incision and curettage, simple excision, excision and cautery, and cryotherapy, especially in symptomatic patients, as these methods have been shown to be effective in reducing the risk of recurrence and allowing the host immunologic response to eliminate residual virus 1.
Treatment Options
The treatment of Molluscum contagiosum depends on the severity of symptoms and the number of lesions. Some key points to consider include:
- Removal of lesions is indicated in symptomatic patients to reduce the risk of recurrence and allow the host immunologic response to eliminate residual virus 1.
- Treatment options include incision and curettage, simple excision, excision and cautery, and cryotherapy 1.
- In patients with multiple lesions, care should be taken to identify and treat nascent lesions to reduce the risk of recurrence 1.
- The conjunctivitis associated with Molluscum contagiosum may require weeks to resolve after elimination of the lesion 1.
Considerations
When treating Molluscum contagiosum, it is essential to consider the following:
- Adults with large and multiple molluscum lesions and relatively little conjunctival inflammation may indicate an immunocompromised state 1.
- Follow-up is not usually necessary unless the conjunctivitis persists 1.
- Referral to a dermatologist may be necessary for examination of other suspicious lesions 1.
Comparison with Other Evidence
While other studies have suggested the use of topical treatments such as potassium hydroxide and imiquimod, the most recent and highest quality study 1 prioritizes removal of lesions through physical destruction methods. The use of cryotherapy with liquid nitrogen, curettage, and application of cantharidin may be considered, but the evidence for their effectiveness is not as strong as that for the methods recommended in the most recent study 1.
From the FDA Drug Label
Imiquimod cream was evaluated in two randomized, vehicle-controlled, double-blind trials involving 702 pediatric subjects with molluscum contagiosum (MC) (470 exposed to imiquimod; median age 5 years, range 2-12 years). These studies failed to demonstrate efficacy
- The treatment options for Molluscum contagiosum are not established for imiquimod cream, as the studies failed to demonstrate efficacy 2.
- No conclusion can be drawn about the effectiveness of imiquimod cream for Molluscum contagiosum.
From the Research
Treatment Options for Molluscum Contagiosum
The treatment options for Molluscum contagiosum include:
- Destructive therapies, such as curettage, cryotherapy, cantharidin, and keratolytics 3
- Immunomodulators, including imiquimod, cimetidine, and Candida antigen 3, 4
- Antivirals, such as cidofovir 3
- Watchful waiting, which can be an appropriate management strategy for some patients 3, 5
- Physician-administered and patient-administered therapies, including novel patient-administered treatment options that can be administered in the privacy of a patient's home 5
- Topical imiquimod, which has been used to treat both Molluscum contagiosum and herpes simplex virus cutaneous infections 6
Special Considerations
Special considerations for treating Molluscum contagiosum include:
- Atopic dermatitis, where treatment may be necessary to alleviate discomfort and itching 3, 7
- Skin of color, where treatment options may need to be tailored to the individual patient's needs 7
- Immunocompromised patients, who may have increased difficulty in clearing lesions and may require more aggressive treatment 5
- Genital Molluscum contagiosum, where treatment is often recommended to reduce the risk of sexual transmission and improve patient quality of life 5