What is the best cream to treat skin infections or conditions?

Molluscum Contagiosum Treatment

For molluscum contagiosum in children, imiquimod 5% cream applied three times weekly is an effective and safe first-line topical therapy, achieving complete or partial remission in approximately 70% of cases. 1, 2

Primary Treatment Approach

Imiquimod 5% cream is the recommended topical agent based on clinical evidence:

• Apply once daily under occlusion, or three times weekly without occlusion, for 3-16 weeks until lesions clear 1, 2
• Achieves complete remission in 13-74% of patients and partial remission (>55% lesion reduction) in an additional 54-69% of cases 1, 2
• Well-tolerated with only local side effects (mild to moderate irritation, erythema in 85%, itching in 75%) and no systemic adverse reactions 1, 3, 2
• Particularly useful for children with multiple or disseminated lesions where surgical approaches would be painful or impractical 1, 2

The mechanism of action involves stimulating innate cutaneous immunity through Toll-like receptor 7/8 agonism, inducing dense lymphocytic (especially T-cell) infiltrates around lesions that lead to resolution 1, 3

Alternative Topical Therapies

Podophyllotoxin cream is an effective alternative option:

• Use 0.5% podophyllotoxin cream (more efficacious than 0.3% concentration) applied twice daily for 3 consecutive days 4
• If incomplete clearance, extend treatment to 24 applications over 4 weeks 4
• Achieves complete cure in 92% of patients with this regimen 4
• Well-tolerated with mild side effects (pruritus 20.6%, erythema 18%) 4
• Suitable for home-based self-administration 4

Potassium hydroxide 10% solution is another validated option:

• Apply three times weekly until lesions clear 3
• Statistically significant reduction in lesion counts through 12 weeks of treatment 3
• Over 40% develop local side effects, but no systemic adverse reactions 3
• Comparable efficacy to imiquimod 3

Treatment Duration and Monitoring

• Assess response at weeks 2,4,8, and 12 during treatment 3, 2
• Complete remission typically occurs within 3-8 weeks for responders, though treatment may extend to 16 weeks 1, 2
• No recurrence observed in successfully treated patients during 6-9 months follow-up 4

Important Clinical Considerations

Treatment is advisable despite the self-limited nature of molluscum contagiosum because of:

• Risk of autoinoculation and transmission to others 1
• Potential for superinfection and scarring 1
• Protracted course that may last months to years without intervention 1

Common pitfalls to avoid:

• Do not dismiss topical imiquimod based solely on unpublished FDA trials; multiple peer-reviewed studies demonstrate efficacy and safety 1
• Discontinue treatment if severe local reactions develop (occurs in approximately 23% of patients) 2
• Recognize that approximately 30% of patients may show stable or progressive disease and require alternative approaches 2

When Topical Therapy Fails

Consider ablative procedures (curettage, cryotherapy, electrodessication, laser therapy) for refractory cases or when topical treatments are not tolerated 1