What can treat molluscum contagiosum?

From the Guidelines

Molluscum contagiosum can be effectively treated with cryotherapy, which is a recommended treatment option due to its efficacy and relatively low risk of complications, as supported by the most recent study 1. When considering treatment options for molluscum contagiosum, it's essential to weigh the benefits and risks of each approach. The primary goal is to minimize morbidity, mortality, and improve quality of life.

• Watchful waiting is a reasonable approach for mild cases, as the infection often resolves on its own within 6-12 months, though it may take up to 2 years.
• Medical treatments, such as topical therapies, may not be as effective, and their use should be considered on a case-by-case basis.
• Physical removal methods, including cryotherapy with liquid nitrogen, curettage, and laser therapy, can be effective in removing lesions and reducing the risk of recurrence.
• It's crucial to avoid scratching lesions to prevent spreading the infection to other body areas or to other people, as the virus is highly contagious through direct contact. The most recent study 1 provides guidance on treatment options, including incision and curettage, simple excision, excision and cautery, and cryotherapy, which can be effective in removing lesions and reducing the risk of recurrence.
• In patients with multiple lesions, care should be taken to identify and treat nascent lesions to reduce the risk of recurrence.
• Reduction of the viral load often allows the host immunologic response to eliminate residual virus.
• Follow-up is not usually necessary unless the conjunctivitis persists, and referral to a dermatologist may be necessary for examination of other suspicious lesions.

From the FDA Drug Label

Imiquimod cream was evaluated in two randomized, vehicle-controlled, double-blind trials involving 702 pediatric subjects with molluscum contagiosum (MC) (470 exposed to imiquimod; median age 5 years, range 2-12 years). These studies failed to demonstrate efficacy

• Imiquimod may not be effective for treating molluscum contagiosum, as the studies failed to demonstrate efficacy 2.
• The FDA drug label does not provide sufficient evidence to support the use of imiquimod for treating molluscum contagiosum 2.

From the Research

Treatment Options for Molluscum Contagiosum

• Imiquimod 5% cream: a slow-acting but effective agent for the treatment of molluscum contagiosum in children, with a complete cure rate of 91.8% 3
• Cryotherapy: a rapidly effective treatment, with a complete cure rate of 100% in one study 3 and 93.3% in another study 4
• 10% potassium hydroxide solution: a cheap, easily available, and cosmetically acceptable treatment, with a complete response rate of 86.6% 4 and 80% in another study 5
• Other treatment options:
  • Cantharidin
  • Podophyllotoxin
  • Benzoyl peroxide
  • Tretinoin
  • Trichloroacetic acid
  • Lactic acid
  • Glycolic acid
  • Salicylic acid
  • Imiquimod
  • Interferon-alpha
  • Cimetidine
  • Cidofovir
  • Pulsed dye laser therapy
  • Curettage 6, 7

Comparison of Treatment Options

• Imiquimod 5% cream versus cryotherapy: no statistically significant difference in overall complete cure rate, but cryotherapy was more painful and had more side effects 3
• 10% potassium hydroxide solution versus cryotherapy: no statistically significant difference in lesion clearance, with a complete clearance rate of 80% for potassium hydroxide and 83.3% for cryotherapy 5
• 10% potassium hydroxide solution versus cryotherapy: similar efficacy, with a complete response rate of 86.6% for potassium hydroxide and 93.3% for cryotherapy 4