From the Guidelines
Treatment of molluscum contagiosum should be focused on removing the lesions, especially in symptomatic patients, with options including incision and curettage, simple excision, excision and cautery, and cryotherapy, as these methods can help reduce the viral load and allow the host immunologic response to eliminate residual virus. When considering treatment, it's essential to note that molluscum contagiosum can persist for months to years if left untreated, but it may also spontaneously resolve 1. Key points to consider in treatment include:
- Identifying and treating nascent lesions to reduce the risk of recurrence
- Recognizing that conjunctivitis may require weeks to resolve after elimination of the lesion
- Being aware that large and multiple molluscum lesions with relatively little conjunctival inflammation in adults may indicate an immunocompromised state 1
- Considering referral to a dermatologist for examination of other suspicious lesions Treatment approaches should prioritize methods that effectively reduce the viral load, allowing the body's immune system to clear the infection, and should be guided by the presence of symptoms and the overall health status of the patient 1.
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
The FDA drug label does not support the use of imiquimod cream for the treatment of molluscum contagiosum, as the studies failed to demonstrate efficacy 2.
From the Research
Treatment Options for Molluscum Contagiosum
- There are various treatment approaches for molluscum contagiosum, including curettage, cantharidin, and topical treatments such as podophyllotoxin, imiquimod, and sodium nitrite 3, 4, 5, 6.
- Curettage is a commonly used treatment modality, which has been shown to be effective and well-tolerated by patients, with high satisfaction rates and fast cure rates 4, 7.
- Cantharidin is another treatment option, which has been described as a practical approach for treating molluscum contagiosum, with detailed information on distribution sources, application, and caveats regarding its use 5.
- Topical treatments have also been evaluated in randomized controlled trials, with varying degrees of efficacy, and may provide an alternative to mechanical methods such as cryotherapy and curettage 6.
Special Considerations
- Treatment approaches may vary depending on the patient's age, skin type, and other factors, such as atopic dermatitis or skin of color 3.
- The decision to treat molluscum contagiosum should be based on individual patient needs, taking into account the potential benefits and risks of treatment, as well as the patient's preferences and values 3, 7.
- Active treatment should be offered to patients with molluscum contagiosum, despite the fact that it is a self-limiting condition, in order to alleviate discomfort and itching, prevent scarring and superinfection, and eliminate social stigma 7.