What are the treatment options for molluscum contagiosum lesions on the arm?

Treatment Options for Molluscum Contagiosum Lesions on the Arm

Physical removal methods, including cryotherapy with liquid nitrogen, curettage, and excision, are the recommended first-line treatments for molluscum contagiosum lesions on the arm. 1

First-Line Treatment Options

• Cryotherapy with liquid nitrogen is highly effective for molluscum contagiosum lesions on the arm, with studies showing complete clearance rates of up to 94% 2
• Curettage and simple excision are effective physical removal methods recommended by the American Academy of Ophthalmology for molluscum contagiosum lesions 1
• 10% potassium hydroxide solution is a recommended first-line topical chemical treatment with similar efficacy to cryotherapy 1
• Cantharidin application has shown effectiveness in observational studies, though randomized controlled trial evidence is limited 1

Comparing Treatment Efficacy

• Cryotherapy demonstrates faster resolution compared to other treatments, with studies showing 70% of patients achieving complete clearance after just 3 weeks of treatment 3
• 10% potassium hydroxide solution has been shown to be as effective as cryotherapy in randomized clinical trials, with 86.6% complete response rate after 4 weeks 4
• 10% benzoyl peroxide cream has demonstrated superior efficacy compared to 0.05% tretinoin in treating molluscum contagiosum lesions 5
• The combination of 5% sodium nitrite with 5% salicylic acid is more effective than 5% salicylic acid alone 5

Treatment Selection Considerations

• Cryotherapy may be preferred for larger solitary lesions or when rapid treatment is desired, but carries risk of pain, bullae formation, and pigmentary changes 3
• 10% potassium hydroxide is inexpensive and provides better cosmetic results compared to cryotherapy, making it suitable for widespread lesions 4
• For multiple small lesions, topical treatments may be more practical and less painful than physical removal methods 3
• All treatment approaches should aim to identify and treat all lesions, including nascent ones, to reduce risk of recurrence 1

Important Cautions

• Imiquimod 5% cream has not shown benefit compared to placebo in randomized controlled trials and is not recommended by the American Academy of Pediatrics 1
• FDA labeling specifically states that imiquimod cream was evaluated in children with molluscum contagiosum and failed to demonstrate efficacy 6
• Cryotherapy may be associated with postinflammatory hyperpigmentation or, uncommonly, scarring 1
• Extensive or recalcitrant disease may indicate an immunocompromised state and warrant further evaluation 1

Treatment Algorithm

1. For limited number of lesions or when rapid treatment is desired:

   • Cryotherapy with liquid nitrogen (weekly applications until resolution) 2
   • Curettage or simple excision for larger, well-defined lesions 1

2. For multiple or widespread lesions:

   • 10% potassium hydroxide solution applied twice daily until lesions resolve 4
   • Cantharidin application by a healthcare provider 1, 7

3. For patients concerned about pain or cosmetic outcomes:

   • 10% potassium hydroxide solution is less painful and provides better cosmetic results than cryotherapy 4
   • 10% benzoyl peroxide cream is an effective alternative 5