Aldara (Imiquimod) for Molluscum Contagiosum in Adults
Aldara (imiquimod) is not recommended for treating molluscum contagiosum in adults, as it has not shown benefit compared to placebo in randomized controlled trials. 1
Why Imiquimod Should Not Be Used
The American Academy of Pediatrics explicitly states that imiquimod was not shown to be of benefit compared with placebo for treating molluscum contagiosum and should not be used. 1 This recommendation applies to both children and adults, as the mechanism of viral clearance is similar across age groups.
While older observational studies from 2000-2004 suggested potential efficacy 2, 3, 4, these were small, uncontrolled case series that did not hold up when subjected to rigorous randomized controlled trial methodology. The guideline evidence clearly supersedes these earlier preliminary reports.
Recommended First-Line Treatments for Adults
Physical removal methods are the recommended first-line therapy for molluscum contagiosum in adults. 5 These include:
- Incision and curettage - most effective physical removal method 5
- Simple excision or excision with cautery - equally effective alternatives 5
- Cryotherapy with liquid nitrogen - another first-line option 5
Treatment Algorithm
When treating molluscum contagiosum in adults, follow this approach:
- Confirm diagnosis by identifying characteristic skin-colored, whitish, or pink papules with shiny surface and central umbilication 5
- Assess disease extent - look for number of lesions, distribution, and presence of conjunctivitis if periocular 5
- Screen for immunocompromise if multiple large lesions are present with minimal inflammation 5
- Treat all visible lesions including nascent ones to reduce recurrence risk 5
- Consider dermatology referral for extensive disease or immunocompromised patients 5
Important Caveats
- Reducing viral load through physical removal allows the host immune response to eliminate residual virus 5
- For periocular lesions with associated conjunctivitis, lesion removal is mandatory, though conjunctivitis may take weeks to resolve after treatment 5
- Follow-up is not usually necessary unless conjunctivitis persists or new lesions develop 5
- Multiple large lesions with minimal inflammation should prompt evaluation for immunocompromised state 5