What is the treatment for molluscum contagiosum with secondary cellulitis?

Treatment of Molluscum Contagiosum with Secondary Cellulitis

For molluscum contagiosum with secondary cellulitis, treatment should include both antibiotic therapy targeting Gram-positive bacteria (especially streptococci and Staphylococcus aureus) for the cellulitis component and appropriate management of the underlying molluscum lesions. 1

Management of Secondary Cellulitis

Antibiotic Therapy

• For mild cellulitis with no significant comorbidities:

  • Oral beta-lactams (in areas where CA-MRSA is not prevalent) 1
  • Alternative options include macrolides and lincosamides, though resistance is increasing
  • Treatment should begin promptly with agents effective against typical Gram-positive pathogens

• For more severe infections:

  • Parenteral antibiotics are the first choice 1
  • If MRSA is suspected (either hospital-acquired or community-acquired):
    • Glycopeptides or newer antimicrobials are recommended 1

Duration of Therapy

• Continue antibiotics until resolution of cellulitis signs (erythema, warmth, tenderness, lymphangitis)
• Typically 7-10 days of therapy, but may need to be extended based on clinical response

Management of Molluscum Contagiosum Lesions

Once the cellulitis is controlled, treatment of the underlying molluscum should be addressed to prevent recurrence:

Treatment Options

1. Physical Removal Methods:

   • Cryotherapy with liquid nitrogen (93.3% complete response rate) 2
   • Curettage (highly effective with 70% cure after one treatment) 3
   • Incision and drainage for larger lesions

2. Topical Treatments:

   • Cantharidin (well-tolerated and effective) 2
   • 10% Potassium Hydroxide (KOH) (comparable efficacy to cryotherapy) 2

3. Newer Treatment Options (not yet FDA approved):

   • VP-102 (standardized cantharidin preparation) 4
   • SB206 (topical nitric oxide-releasing product) 4

Prevention of Spread and Recurrence

• Cover visible lesions with clothing or bandages 2
• Maintain good hand hygiene, especially after touching lesions 2
• Avoid sharing personal items like towels and clothing 2
• Use separate towels for infected individuals 2
• Clean and disinfect shared surfaces that may contact lesions 2

Special Considerations

• Immunocompromised patients may develop more severe and recalcitrant molluscum lesions requiring specialized treatment with cidofovir, imiquimod, or interferon 5
• Lesions near the eyes require prompt treatment to prevent ocular complications like conjunctival scarring, epithelial keratitis, and pannus formation 2
• Children: Consider less painful treatment options; curettage has shown high satisfaction rates (97%) in appropriate settings 3

Follow-up

• Regular monitoring every 1-3 months to assess progression 2
• Consider active treatment if lesions persist beyond 6-12 months or if complications develop 2
• Screen for other sexually transmitted infections if the molluscum is sexually transmitted 5

Common Pitfalls to Avoid

1. Failing to treat the cellulitis adequately before addressing the molluscum lesions
2. Overlooking the potential for self-inoculation and spread to other body areas
3. Not recognizing that molluscum can spread during bathing/showering if towels or washcloths are shared 2
4. Neglecting to screen for immunocompromised status, which may require more aggressive therapy
5. Assuming all treatments are equally appropriate for all patients (children may require different approaches than adults)