What are the treatment options for Molluscum contagiosum?

Treatment of Molluscum Contagiosum

Physical removal methods—including cryotherapy with liquid nitrogen, curettage, or excision—are the recommended first-line treatments for molluscum contagiosum to prevent transmission and reduce symptoms. 1, 2

Treatment Algorithm

For Immunocompetent Patients (Children and Adults)

Physical Removal Methods (First-Line):

• Cryotherapy with liquid nitrogen is the primary recommended treatment 1, 2
• Curettage (incision and curettage) is equally effective as first-line therapy 1, 2
• Simple excision or excision with cautery are alternative first-line options 1, 2
• Treat all visible lesions, including nascent ones, to reduce recurrence risk 1, 2

Topical Chemical Treatments (Alternative First-Line):

• 10% potassium hydroxide solution has similar efficacy to cryotherapy in children 1
• Cantharidin has shown effectiveness in observational studies, though randomized controlled trial evidence is limited 1

Important Caveat: Cryotherapy may cause postinflammatory hyperpigmentation or, uncommonly, scarring 1

For Genital Molluscum Contagiosum

Physical treatments remain first-line:

• Cautery, curettage, or cryotherapy are recommended 3
• Podophyllotoxin and imiquimod are topical chemical options for genital lesions 3
• Screen patients for other sexually transmitted infections 3
• In pregnancy, physical procedures like cryotherapy are safe 3

For Immunocompromised Patients

• Extensive or recalcitrant disease should prompt screening for immunocompromised state 1, 2
• Multiple large lesions with minimal inflammation indicate possible immunocompromised state 1, 2
• Severe cases may require cidofovir, imiquimod, or interferon 3
• Referral to dermatology is necessary for extensive disease 1, 2

Special Considerations

Periocular Lesions:

• Remove lesions on or near eyelids if associated conjunctivitis is present 1, 2
• Conjunctivitis may require weeks to resolve after lesion elimination 2
• Monitor for persistent conjunctivitis requiring follow-up 1, 2

Watchful Waiting:

• Spontaneous resolution is an option for immunocompetent patients, though lesions typically persist 6-12 months and can last up to 4-5 years 1, 4
• Treatment is preferred to reduce transmission risk, prevent autoinoculation, and improve quality of life 5

Treatments NOT Recommended

Avoid these interventions:

• Imiquimod has NOT shown benefit compared to placebo in randomized controlled trials and is not recommended by the American Academy of Pediatrics 1
• Ranitidine has no evidence supporting efficacy for molluscum contagiosum 4
• Salicylic acid is contraindicated in children under 2 years due to systemic toxicity risk 4

Common Pitfalls

• Failing to treat all lesions including nascent ones increases recurrence risk 1, 2
• Reducing viral load through treatment allows the host immune response to eliminate residual virus 1, 2
• Missing signs of immunocompromised state (multiple large lesions with minimal inflammation) delays appropriate workup 1, 2
• Follow-up is generally not necessary unless conjunctivitis persists or new lesions develop 1, 2