Salicylic Acid for Molluscum Contagiosum in a 2-Year-Old
Salicylic acid is contraindicated for treating molluscum contagiosum in children under 2 years of age due to the risk of systemic toxicity. 1, 2
Safety Concerns
- Salicylic acid is explicitly contraindicated in children under 2 years of age according to FDA labeling 1
- There is an increased risk of salicylate toxicity with use in young children due to their higher body-surface-to-mass ratio, which increases systemic absorption 2
- Life-threatening toxicity has been reported in young children with the use of salicylic acid 2
- The 2025 British Journal of Dermatology guidelines specifically state that "salicylic acid and lactic acid are strictly contraindicated in children under the age of 2 years" 2
Alternative Management Options for Molluscum in Young Children
- Watchful waiting is a reasonable approach as molluscum contagiosum typically resolves spontaneously within 6-12 months, though complete resolution can take up to 4 years 2
- For lesions that are cosmetically bothersome or in children with underlying skin conditions like eczema, the following alternatives may be considered:
- 10% potassium hydroxide has shown efficacy in children and appears to have a better safety profile than salicylic acid for this age group 2, 3
- Cantharidin can be effective according to observational studies, though it may cause blistering 2
- Cryotherapy with liquid nitrogen has similar efficacy to other treatments but may cause postinflammatory hyperpigmentation or scarring 2
Treatment Efficacy Considerations
- In comparative studies of molluscum treatments, salicylic acid combinations have shown efficacy but with higher rates of side effects (53.5%) compared to other treatment modalities 4
- A randomized control trial found that 30% salicylic acid was effective for molluscum contagiosum with 63.33% of patients achieving complete clearance, but this study did not include children under 2 years 5
- When comparing 10% potassium hydroxide solution versus salicylic and lactic acid combination in children, both were found to be equally effective, but safety concerns remain for very young children 3
Important Considerations
- If any treatment is considered for molluscum in children under 2 years, it should be limited to very small areas and under close medical supervision 2
- Pediatric guidelines emphasize that no single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum, making watchful waiting a reasonable approach 6
- Secondary bacterial infection is a potential complication of any irritating topical treatment for molluscum 5
- Parents should be counseled about the self-limiting nature of molluscum contagiosum and the risks associated with aggressive treatment in very young children 2, 6