Treatment Options for Molluscum Contagiosum
The first-line treatment for molluscum contagiosum includes physical removal methods such as incision and curettage, simple excision, excision and cautery, or cryotherapy with liquid nitrogen, as recommended by the American Academy of Ophthalmology. 1, 2
Clinical Presentation and Diagnosis
- 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 1
- The condition is caused by a poxvirus and transmitted through direct skin contact, fomites, or self-inoculation 2
- Lesions typically persist for 6 months to 5 years without treatment 1, 3
- Associated conjunctivitis may be present if lesions are located on or near the eyelids 1
- Multiple large lesions with minimal inflammation may indicate an immunocompromised state 2
Treatment Algorithm
First-Line Physical Treatments
- Incision and curettage is recommended as an effective physical removal method 1, 2
- Simple excision or excision and cautery are equally effective first-line options 2
- Cryotherapy with liquid nitrogen is another recommended first-line treatment 1, 2
- When treating, identify and address all lesions, including nascent ones, to reduce the risk of recurrence 1
Topical Chemical Treatments
- 10% potassium hydroxide solution has similar efficacy to cryotherapy in children 1, 4
- Cantharidin has shown effectiveness in observational studies, though randomized controlled trial evidence is limited 1, 5
Special Populations
- For children under 2 years, salicylic acid is contraindicated due to risk of systemic toxicity 4
- For lesions on or near eyelids with associated conjunctivitis, removal of the lesion is indicated 2
- In immunocompromised patients with extensive disease, consider referral to dermatology 2
- For genital molluscum contagiosum, patients should be screened for other sexually transmitted infections 6
Important Considerations
- Reducing viral load through treatment often allows the host immune response to eliminate residual virus 1
- Watchful waiting is a reasonable approach as molluscum contagiosum typically resolves spontaneously within 6-12 months to several years 4, 7
- Reasons for active treatment include alleviating discomfort and itching, limiting spread, preventing scarring and superinfection, and eliminating social stigma 5
- Follow-up is not usually necessary unless conjunctivitis persists or new lesions develop 2
Treatment Efficacy and Limitations
- No single treatment is uniformly effective for all patients 5, 7
- Imiquimod has not shown benefit compared to placebo in randomized controlled trials and is not recommended by the American Academy of Pediatrics 1
- Ranitidine (cimetidine) is not recommended for molluscum contagiosum as there is no evidence supporting its efficacy 4
- Cryotherapy may be associated with postinflammatory hyperpigmentation or, uncommonly, scarring 1
- Destructive therapies are often poorly tolerated in children 7
Treatment for Recalcitrant or Extensive Disease
- For extensive or recalcitrant disease, consider screening for immunocompromised state 1, 4
- Immunosuppressed patients may require treatment with cidofovir, imiquimod, or interferon for severe and recalcitrant lesions 6
- In patients with atopic dermatitis, more aggressive treatment may be needed as they tend to develop widespread involvement 7