Treatment Options 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, 2
First-Line Treatment Options
- Cryotherapy with liquid nitrogen is an effective first-line treatment for molluscum contagiosum in both children and adults 1, 2
- Incision and curettage is highly effective for physical removal of molluscum lesions and is recommended by the American Academy of Ophthalmology 2
- Simple excision or excision and cautery are equally effective first-line options for treating molluscum contagiosum 1, 2
- 10% potassium hydroxide solution is recommended as a topical chemical treatment with similar efficacy to cryotherapy, particularly in children 1
- Cantharidin has shown effectiveness in observational studies, though randomized controlled trial evidence is limited 1, 3
Treatment Approach Based on Patient Factors
For Children:
- Physical removal methods may be less tolerated in young children 4
- 10% potassium hydroxide solution is a good alternative to cryotherapy for children 1
- Avoid salicylic acid in children under 2 years due to risk of systemic toxicity 5
- Watchful waiting is reasonable as molluscum typically resolves spontaneously within 6-12 months, though it may persist for up to 5 years 1, 6
For Adults:
- Physical removal methods (cryotherapy, curettage, excision) are preferred first-line options 2
- For genital lesions, treatment is recommended to reduce sexual transmission risk 6, 7
- For extensive disease, consider screening for immunocompromised state 1, 2
Special Considerations:
- For lesions near the eyes with associated conjunctivitis, removal is indicated with monitoring for resolution of conjunctivitis 1, 2
- In pregnancy, physical procedures like cryotherapy are considered safe 7
- Immunocompromised patients may require more aggressive treatment approaches 7
Important Treatment Considerations
- When treating, identify and address all lesions, including nascent ones, to reduce recurrence risk 1, 2
- Reducing viral load through treatment often allows the host immune response to eliminate residual virus 2
- Cryotherapy may be associated with postinflammatory hyperpigmentation or, uncommonly, scarring 1
- Follow-up is not usually necessary unless conjunctivitis persists or new lesions develop 2
Treatments Not Recommended
- Imiquimod has not shown benefit compared to placebo in randomized controlled trials for molluscum contagiosum and is not recommended 1
- FDA labeling specifically states that imiquimod cream has been evaluated in children ages 2 to 12 years with molluscum contagiosum and these studies failed to demonstrate efficacy 8
- Ranitidine is not recommended for molluscum contagiosum as there is no evidence supporting its efficacy 5
Reasons for Treatment
- Treatment may be indicated to alleviate discomfort and itching, particularly in patients with associated eczematous eruption 3, 6
- Other reasons include limiting spread to other areas and people, preventing scarring and superinfection, and eliminating social stigma of visible lesions 3, 6
- For genital molluscum contagiosum, treatment is recommended to reduce sexual transmission risk 6, 7