Tretinoin for Molluscum Contagiosum
Tretinoin is not recommended as a first-line treatment for molluscum contagiosum and has limited evidence supporting its use, with physical removal methods (curettage, cryotherapy) or 10% potassium hydroxide being the preferred first-line options. 1, 2
Evidence for Tretinoin
- Tretinoin showed inferior efficacy compared to 5% potassium hydroxide in a randomized trial, with slower response rates and some lesions persisting beyond 4 weeks of treatment 3
- In the comparative study, tretinoin 0.05% cream reduced mean lesion count from 8.35 to 2.00 over 4 weeks, while 5% KOH achieved faster resolution (from 9.48 to 1.67 lesions) 3
- Tretinoin demonstrated fewer side effects than KOH but was associated with delayed clinical response, making it potentially useful only in recurrent cases where tolerability is prioritized over speed of resolution 3
- One case report described successful treatment with adapalene (a retinoid) for generalized, recurrent molluscum with minimal irritation, but this represents only anecdotal evidence 4
- A Cochrane systematic review found low-quality evidence that 10% benzoyl peroxide was more effective than 0.05% tretinoin for achieving short-term clinical cure (RR 2.20,95% CI 1.01 to 4.79) 5
Recommended First-Line Treatments Instead
- Physical removal methods (incision and curettage, simple excision, cryotherapy) are recommended as first-line therapy for symptomatic lesions, multiple lesions, or periocular lesions 1, 2, 6
- Cryotherapy with liquid nitrogen achieves complete response in approximately 93% of cases, though it carries risk of postinflammatory hyperpigmentation or scarring 1, 2
- 10% potassium hydroxide solution is recommended as first-line chemical treatment with similar efficacy to cryotherapy (86.6% vs 93.3% complete response) and better cosmetic results 1, 2
When to Consider Watchful Waiting
- Watchful waiting is reasonable for asymptomatic lesions, limited disease, and no periocular involvement, as spontaneous resolution typically occurs in 6-12 months (though can take up to 4-5 years) 1, 2, 6
Treatments to Avoid
- Imiquimod 5% should not be used, as high-quality evidence from multiple randomized controlled trials showed no benefit compared to placebo for clinical cure at 12,18, and 28 weeks, despite causing more application site reactions 1, 5
Clinical Context
- The primary rationale for treating molluscum contagiosum is to prevent transmission, reduce autoinoculation, address cosmetic concerns, and resolve associated conjunctivitis when lesions are periocular 1, 2, 6
- Treating all lesions, including nascent ones, reduces recurrence risk by lowering viral load and allowing the host immune response to eliminate residual virus 1, 6