Treatment for Molluscum Contagiosum
Physical removal methods, including incision and curettage, simple excision, excision and cautery, or cryotherapy, are recommended as first-line therapy for molluscum contagiosum to prevent transmission and reduce associated symptoms. 1
First-Line Treatment Options
- Cryotherapy with liquid nitrogen is a recommended first-line treatment for molluscum contagiosum according to the American Academy of Pediatrics 1, 2
- Incision and curettage is an effective physical removal method for treating molluscum contagiosum 1, 3
- Simple excision or excision and cautery are equally effective first-line options 1, 3
- 10% potassium hydroxide solution is recommended as a topical chemical treatment with similar efficacy to cryotherapy, particularly in children 1, 2
- Cantharidin has shown effectiveness in observational studies, though randomized controlled trial evidence is limited 1, 2
Treatment Algorithm
For Immunocompetent Patients:
- Identify and treat all lesions, including nascent ones, to reduce risk of recurrence 1
- Reducing viral load through treatment often allows the host immune response to eliminate residual virus 1, 3
- For limited disease, proceed with physical removal methods 3
- For lesions near the eyes with associated conjunctivitis, removal of the lesion is indicated 1, 3
For Special Populations:
- For children, consider less painful options such as topical treatments (10% potassium hydroxide) 2
- For extensive or recalcitrant disease, consider screening for immunocompromised state 1, 3
- For immunocompromised patients with severe or recalcitrant lesions, referral to dermatology may be necessary 1, 3
Important Considerations
- Molluscum contagiosum typically persists for 6 months to 5 years without treatment 1, 4
- Follow-up is not usually necessary unless conjunctivitis persists or new lesions develop 1, 3
- Cryotherapy may be associated with postinflammatory hyperpigmentation or, uncommonly, scarring 1
- For children under 2 years, salicylic acid is contraindicated due to risk of systemic toxicity 2
Treatments to Avoid
- Imiquimod has not shown benefit compared to placebo in randomized controlled trials for molluscum contagiosum and is not recommended by the American Academy of Pediatrics 1, 5
- High-quality evidence from multiple studies shows that 5% imiquimod is no more effective than vehicle (placebo) for treating molluscum contagiosum 5, 6
- Ranitidine is not recommended for molluscum contagiosum as there is no evidence supporting its efficacy for this condition 2
Monitoring and Follow-up
- If lesions are near the eyes with associated conjunctivitis, monitor for resolution of conjunctivitis after lesion removal 1
- Conjunctivitis may require weeks to resolve after elimination of the lesion 3
- Multiple large lesions with minimal inflammation should prompt consideration of an immunocompromised state 1, 3