Can Topical Potassium Hydroxide Be Used in Adults for Molluscum Contagiosum?
Yes, topical potassium hydroxide (KOH) can be used in adults for molluscum contagiosum, though physical removal methods (curettage, excision, or cryotherapy) remain the guideline-recommended first-line therapy. 1
Guideline-Recommended First-Line Approach for Adults
The American Academy of Ophthalmology specifically addresses adult treatment and recommends physical removal as the primary approach:
- Incision and curettage, simple excision, or excision with cautery are the recommended first-line treatments for adults 1
- Cryotherapy with liquid nitrogen is an equally effective first-line alternative 1
- Physical removal is particularly important for lesions near the eyes causing conjunctivitis, as the conjunctivitis may require weeks to resolve after lesion elimination 1
Evidence Supporting KOH Use in Adults
While guidelines prioritize physical removal, research demonstrates KOH effectiveness in adults:
- 20% KOH solution applied twice daily showed improvement of genital molluscum lesions by day 20 in adults with sexually transmitted infections 2
- Once-daily application of 20% KOH cleared genital lesions in 25-31 days 2
- The treatment was described as "effective, practical, and inexpensive" for adult patients 2
Practical Application in Adults
If choosing KOH for adult patients, use 10-20% concentration:
- 10% KOH once or twice daily is the standard pediatric concentration that can be extrapolated to adults 2
- 20% KOH once daily is commonly used in both children and adults 2
- 20% KOH twice daily has been reported specifically for adult genital lesions with faster clearance 2
Expected Side Effects
Anticipate tolerable local reactions:
- Stinging and burning sensation for several minutes after application 2
- Erosions at application sites 2
- Post-inflammatory hypo- and hyperpigmentation 2
- These effects are generally well-tolerated and resolve after treatment completion 2
Clinical Algorithm for Adult Treatment Selection
Choose physical removal when:
- Multiple lesions are present 1
- Lesions are periocular with associated conjunctivitis 1
- Patient desires rapid clearance 1
- Patient has extensive disease suggesting immunocompromise 1
Consider KOH when:
- Patient prefers self-administered home treatment 2
- Cost is a significant concern 2
- Physical removal is not readily available 2
- Lesions are in cosmetically sensitive areas where cryotherapy scarring is undesirable 3
Important Caveats
Screen for immunocompromise in adults with extensive disease: Multiple large lesions with minimal inflammation should prompt HIV testing or evaluation for other immunodeficiency states 1
Identify and treat all lesions, including nascent ones: Incomplete treatment is a common cause of recurrence, as reducing viral load allows the host immune response to eliminate residual virus 1
Follow-up is generally unnecessary unless conjunctivitis persists or new lesions develop 1