What are the treatment options for Molluscum contagiosum?

Treatment Options for Molluscum Contagiosum

For bothersome, extensive, or symptomatic molluscum contagiosum lesions, cantharidin is a well-tolerated and effective treatment option with minimal side effects. 1

Treatment Approach

The American Academy of Pediatrics provides several treatment options based on the clinical presentation:

First-line Management

• Observation for spontaneous resolution is appropriate for asymptomatic, limited lesions in immunocompetent patients
  • Spontaneous resolution typically occurs within 6-12 months, though complete resolution may take up to 4 years 1
  • This approach is particularly suitable for young children with limited lesions

Active Treatment Options

When treatment is indicated (extensive lesions, symptomatic cases, risk of spread, or patient preference), options include:

1. Cantharidin

   • Applied by healthcare provider
   • Highly effective with minimal side effects
   • Comparable efficacy to cryotherapy 1, 2

2. 10% Potassium Hydroxide (KOH)

   • 86.6% complete response rate
   • Comparable efficacy to cryotherapy 1

3. Cryotherapy with liquid nitrogen

   • 93.3% complete response rate
   • Potential complications: postinflammatory hyperpigmentation or scarring
   • Consider local anesthesia before treatment for painful lesions 1

4. Physical removal methods

   • Curettage: Effective for immediate removal but potentially painful
   • Simple excision: Effective for isolated, larger lesions
   • Excision and cauterization: More definitive but potentially more painful 1

5. Imiquimod

   • Not more effective than placebo for molluscum contagiosum
   • High-quality evidence shows no difference in clinical cure rates compared to vehicle 1, 3, 4
   • Associated with application site reactions 3, 4

Special Considerations

Location-specific Treatment

• Lesions near the eyes require prompt treatment to prevent ocular complications:
  • Conjunctival scarring
  • Epithelial keratitis
  • Pannus formation 1

Age-specific Considerations

• Young children: The British Association of Dermatologists recommends avoiding painful treatments if possible, considering the child's ability to cooperate 1
• Pediatric patients: FDA data shows imiquimod is not effective for molluscum in children (24% clearance rate vs 26-28% with vehicle) 3

Prevention of Spread

1. Personal hygiene measures:

   • Regular handwashing, especially after touching lesions
   • Using separate towels for infected individuals
   • Not sharing personal items like towels and clothing 1

2. Lesion management:

   • Cover visible lesions with clothing or bandages when possible
   • Avoid direct skin-to-skin contact between infected and uninfected individuals 1

3. Environmental measures:

   • Clean and disinfect shared surfaces that may contact lesions
   • Wear flip-flops in communal showers
   • Shower thoroughly before and after swimming 1

Follow-up Recommendations

• Regular monitoring every 1-3 months to assess progression
• Consider active treatment if lesions persist beyond 6-12 months or if complications develop 1
• For occupational risk groups (food service workers, athletes, childcare workers), follow specific guidelines including covering lesions and maintaining strict hand hygiene 1

Treatment Pitfalls to Avoid

• Failing to recognize that molluscum can spread during bathing/showering if towels or washcloths are shared 1
• Using imiquimod as first-line therapy, despite evidence showing it is not more effective than placebo 1, 3, 4
• Neglecting to consider the pain associated with certain treatments, particularly in young children 1
• Overlooking the need for prompt treatment of periocular lesions to prevent eye complications 1