Treatment Options for Molluscum Contagiosum
Physical removal methods including curettage, excision, or cryotherapy are the recommended first-line treatments for molluscum contagiosum, particularly for symptomatic lesions, multiple lesions, or those near the eyes. 1, 2, 3
Treatment Algorithm
For Asymptomatic, Limited Disease
- Watchful waiting is reasonable as lesions typically resolve spontaneously in 6-12 months, though can persist up to 4-5 years without treatment 1, 3
- This approach is appropriate for immunocompetent patients with few lesions and no periocular involvement 3
For Active Treatment (Symptomatic, Multiple, or Periocular Lesions)
Physical Removal Methods (First-Line)
- Cryotherapy with liquid nitrogen achieves complete response in approximately 93% of cases 1, 3
- Curettage, simple excision, or excision with cautery are equally effective first-line options 1, 2
- These methods are particularly important for periocular lesions causing conjunctivitis, as physical removal is necessary to resolve the conjunctivitis 1, 2
Important caveat: Cryotherapy carries a higher risk of postinflammatory hyperpigmentation or scarring, making it less cosmetically favorable for facial lesions or patients with darker skin tones 1, 3
Chemical Treatments (Alternative First-Line)
- 10% potassium hydroxide solution has similar efficacy to cryotherapy (86.6% vs 93.3% complete response) with better cosmetic results due to lower risk of hyperpigmentation 1, 3
- Cantharidin has shown effectiveness in observational studies, though randomized controlled trial evidence is limited 1, 4
Age-specific restriction: Salicylic acid is contraindicated in children under 2 years due to risk of systemic toxicity 3
Critical Treatment Principles
- Identify and treat ALL lesions, including nascent ones, as this reduces recurrence risk by lowering viral load and allowing the host immune response to eliminate residual virus 1, 2
- For periocular lesions with conjunctivitis, the conjunctivitis may require several weeks to resolve after lesion removal 1, 2
Treatments to AVOID
- Imiquimod should NOT be used as it showed no benefit compared to placebo in randomized controlled trials 1, 3, 5
- H2 blockers (ranitidine, cimetidine) have no evidence supporting efficacy and are not included in current guidelines 3
Special Populations
Immunocompromised Patients
- Multiple large lesions with minimal inflammation should prompt screening for immunodeficiency 1, 2
- Consider referral to dermatology for extensive or recalcitrant disease 1, 2
- More aggressive treatments may be needed, including cidofovir or interferon 5
Pregnant Patients
- Physical procedures such as cryotherapy are safe to use 5
Adults with Genital Lesions
- Treatment is recommended to reduce sexual transmission risk, prevent autoinoculation, and improve quality of life 6, 5
- Screen for other sexually transmitted infections 5
Prevention and Transmission Control
- Hand hygiene with alcohol-based disinfectant or soap and water is the most important prevention method 1, 3
- Avoid sharing towels, clothing, and personal items 1, 3
- Cover all lesions with waterproof bandages if water exposure is unavoidable 1, 3
- Limit exposure to swimming pools and hot tubs associated with known outbreaks 1