What is the diagnosis and treatment for Molluscum contagiosum?

From the Guidelines

Molluscum contagiosum can be effectively managed with watchful waiting, as it often resolves on its own within 6-12 months, or with treatment options such as cryotherapy or cantharidin for cosmetically bothersome lesions or those in patients with underlying skin conditions. The management of molluscum contagiosum should prioritize the patient's quality of life and minimize the risk of complications. According to the most recent evidence 1, treatment to remove the lesions is indicated in symptomatic patients, and options include incision and curettage, simple excision, excision and cautery, and cryotherapy.

Treatment Options

• Watchful waiting: resolution of uncomplicated molluscum contagiosum typically occurs spontaneously in 6 to 12 months, although complete resolution of lesions can take up to 4 years 1
• Cryotherapy: has been used to treat lesions that occur in locations that are cosmetically bothersome to patients or for patients with underlying skin conditions such as eczema 1
• Cantharidin: open-label and observational studies indicate that cantharidin can be an effective treatment of molluscum contagiosum, although a small randomized controlled trial did not find statistically significant improvement 1

Prevention of Spread

• Avoid sharing towels or clothing
• Cover lesions when possible
• Avoid scratching
• Maintain good hand hygiene

The virus spreads through direct skin contact or contaminated objects, and the body eventually develops immunity to clear the infection, which explains why it often resolves without treatment. In adults, large and multiple molluscum lesions with relatively little conjunctival inflammation may indicate an immunocompromised state 1. Referral to a dermatologist may be necessary for examination of other suspicious lesions.

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 Similar to the studies conducted in adults, the most frequently reported adverse reaction from 2 studies in children with molluscum contagiosum was application site reaction

The Imiquimod Cream was evaluated for the treatment of molluscum contagiosum in pediatric subjects, but the studies failed to demonstrate efficacy. The most frequently reported adverse reaction was application site reaction 2.

From the Research

Definition and Causes of Molluscum Contagiosum

• Molluscum contagiosum (MC) is a self-limited infectious dermatosis caused by the molluscum contagiosum virus (MCV), a virus of the Poxviridae family 3.
• It is transmitted mainly by direct contact with infected skin, which can be sexual, non-sexual, or autoinoculation 3.
• The virus is also transmitted by close physical contact, autoinoculation, and fomites 4.

Clinical Manifestations

• Clinically, MC presents as firm rounded papules, pink or skin-colored, with a shiny and umbilicated surface 3.
• The skin lesions may vary in size, shape, and location, and are more frequent in immunosuppressed patients 3.
• The duration of the lesions is variable, but in most cases, they are self-limited in a period of 6-9 months 3, 5.

Diagnosis

• The diagnosis is based on clinical findings, and a useful clinical tool is dermoscopy 3.
• If the diagnostic doubt persists, confocal microscopy or skin biopsy could be performed 3.

Treatment Options

• The need for active treatment for MC is controversial, but it should be indicated in cases of extensive disease, associated with complications or aesthetic complaints 3.
• Treatment options include mechanical, chemical, immunomodulatory, and antiviral therapies 3, 5, 6, 4.
• Specific treatments that have been studied include cantharidin 5, potassium hydroxide 6, 4, salicylic acid 6, 4, and imiquimod 7.
• There is moderate-quality evidence that topical 5% imiquimod is no more effective than vehicle in terms of clinical cure, but leads to more application site reactions 7.

Management Strategies

• Watchful waiting is often an appropriate management strategy, especially for patients with limited disease and no complications 5, 4.
• The choice of treatment method should depend on the physician's comfort level with the various treatment options, the patient's age, the number and severity of lesions, location of lesions, and the preference of the child/parents 4.