What is the treatment for molluscum contagiosum in adults?

Treatment of Molluscum Contagiosum in Adults

Physical removal methods including incision and curettage, simple excision, excision and cautery, or cryotherapy are the first-line treatments for molluscum contagiosum in adults. 1

Clinical Presentation and Diagnosis

• Molluscum contagiosum presents as characteristic skin-colored, whitish, or pink papules with a shiny surface and central umbilication 1, 2
• The condition is caused by a poxvirus and is transmitted through direct skin contact, fomites, or self-inoculation 1
• Lesions typically persist for 6 months to 5 years without treatment 1, 3
• In adults, large and multiple molluscum lesions with relatively little conjunctival inflammation may indicate an immunocompromised state 4, 1

First-Line Treatment Options

• Incision and curettage (aggressive enough to cause bleeding) is recommended as an effective physical removal method 4, 1
• Simple excision or excision and cautery are equally effective first-line options 4, 1
• Cryotherapy with liquid nitrogen is another recommended first-line treatment 1
• When treating, identify and address all lesions, including nascent ones, to reduce the risk of recurrence 4, 1

Alternative Treatment Options

• 10% potassium hydroxide solution has shown similar efficacy to cryotherapy in clinical studies 1, 5
• Cantharidin has shown effectiveness in observational studies, though randomized controlled trial evidence is limited 1
• Topical imiquimod has been used, though evidence from randomized controlled trials shows limited benefit compared to placebo 1, 5

Special Considerations

• For lesions on or near eyelids with associated conjunctivitis, removal of the lesion is indicated, and the conjunctivitis may require weeks to resolve after elimination of the lesion 4
• In immunocompromised patients (especially those with HIV), molluscum contagiosum can present with severe, extensive, and recalcitrant lesions that may require more aggressive treatment approaches 6, 7
• Treatment with topical immunomodulators including imiquimod cream, interferon-α injections, or cidofovir may be necessary for immunocompromised patients with extensive disease 7

Treatment Algorithm

1. Confirm diagnosis based on characteristic appearance of lesions 1, 2
2. Assess extent of disease and presence of complications such as associated conjunctivitis 4, 1
3. For limited disease in immunocompetent adults:
   • Proceed with physical removal methods (incision and curettage, excision, or cryotherapy) 4, 1
4. For extensive disease or in immunocompromised patients:
   • Consider referral to dermatology 4, 1
   • More aggressive treatment may be required, including combination therapy or systemic approaches 6, 7
5. Follow-up is not usually necessary unless conjunctivitis persists or new lesions develop 4, 1

Pitfalls and Caveats

• Reducing viral load through treatment often allows the host immune response to eliminate residual virus 1
• Multiple large lesions with minimal inflammation should prompt consideration of an immunocompromised state 4, 7
• Although molluscum contagiosum can resolve spontaneously, treatment is recommended to reduce transmission risk, prevent autoinoculation, and improve patient quality of life 3
• In sexually transmitted cases, patients should be screened for other sexually transmitted infections 6