What concentration and frequency of benzoyl peroxide (BPO) is recommended for treating molluscum contagiosum?

Benzoyl Peroxide Treatment for Molluscum Contagiosum

10% benzoyl peroxide cream applied twice daily is recommended for the treatment of molluscum contagiosum, as it has shown superior efficacy compared to other topical treatments. 1

Understanding Molluscum Contagiosum

• Molluscum contagiosum presents as characteristic skin-colored, whitish, or pink papules with a shiny surface and central umbilication, typically affecting the trunk, face, and extremities in children and adolescents 2
• The condition is caused by a poxvirus and is transmitted through direct skin contact, fomites, or self-inoculation, with lesions that may persist for months to years (6 months to 5 years) 2
• In children, the condition commonly affects the trunk, face, and extremities, and is mostly asymptomatic but may present with pain, itching, redness, or occasional bacterial superinfection 3

Treatment Approach

First-Line Treatment Options

• 10% benzoyl peroxide cream has demonstrated superior efficacy compared to 0.05% tretinoin in randomized controlled trials (RR 2.20,95% CI 1.01 to 4.79) 1
• Apply 10% benzoyl peroxide cream twice daily to affected areas until resolution of lesions 1
• The American Academy of Pediatrics recommends physical removal methods and topical treatments as first-line therapy to prevent transmission and reduce associated symptoms 2

Alternative Treatment Options

• 10% potassium hydroxide solution is an effective alternative, showing better results than 2.5% potassium hydroxide solution (66.7% vs 23.1% complete recovery) 4
• 5% potassium hydroxide solution applied twice daily has shown effectiveness, particularly for facial lesions with minimal side effects 4
• Cryotherapy with liquid nitrogen is another recommended first-line treatment according to the American Academy of Pediatrics 2

Application Instructions

• Apply a thin layer of 10% benzoyl peroxide cream directly to each molluscum lesion twice daily 1
• Continue treatment until complete resolution of lesions, which typically takes 4-6 weeks 1, 5
• Identify and treat all lesions, including nascent ones, to reduce risk of recurrence 2

Monitoring and Follow-Up

• Monitor for common side effects including mild pain during application, erythema, and itching 1
• Follow-up is not usually necessary unless conjunctivitis persists (in cases where lesions are near the eyes) 2
• If extensive or recalcitrant disease is present, consider screening for immunocompromised state and referral to dermatology 2

Important Considerations

• Benzoyl peroxide may cause skin dryness, irritation, or bleaching of fabrics, so advise patients to apply carefully and wash hands thoroughly after application 1
• For facial lesions, consider starting with a lower concentration if irritation is a concern 4
• Treatment should be continued until complete resolution of lesions to prevent autoinoculation and spread 2, 5

Special Populations

• For children, the same concentration and frequency can be used, but monitor more closely for irritation 5
• For immunocompromised patients, more aggressive treatment approaches may be needed as lesions can be more extensive and persistent 3