From the Guidelines
Treatment of molluscum contagiosum should be focused on removing the lesions, especially in symptomatic patients, with options including incision and curettage, simple excision, excision and cautery, and cryotherapy. The approach to treating molluscum contagiosum depends on the severity and location of the lesions, as well as the patient's overall health status. According to the most recent guidelines 1, treatment is indicated in symptomatic patients to reduce the risk of recurrence and allow the host immunologic response to eliminate residual virus.
Key Considerations
- Molluscum lesions may spontaneously resolve, but they can also persist for months to years, highlighting the importance of treatment in symptomatic cases.
- In patients with multiple lesions, care should be taken to identify and treat nascent lesions to reduce the risk of recurrence.
- The conjunctivitis associated with molluscum contagiosum may require weeks to resolve after elimination of the lesion.
- Large and multiple molluscum lesions with relatively little conjunctival inflammation in adults may indicate an immunocompromised state, necessitating further evaluation.
Treatment Options
- Incision and curettage: an aggressive approach that can cause bleeding but is effective in removing lesions.
- Simple excision: a surgical approach to remove the lesions.
- Excision and cautery: a combination of surgical removal and cauterization to prevent recurrence.
- Cryotherapy: freezing the lesions with liquid nitrogen to destroy the virus-containing cells.
Additional Recommendations
- Follow-up is not usually necessary unless the conjunctivitis persists, indicating the need for further treatment or evaluation.
- Referral to a dermatologist may be necessary for examination of other suspicious lesions, especially in cases where the diagnosis is uncertain or the patient has a history of skin conditions.
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). Subjects applied imiquimod cream or vehicle 3 times weekly for up to 16 weeks. Complete clearance (no MC lesions) was assessed at Week 18 In Study 1, the complete clearance rate was 24% (52/217) in the imiquimod cream group compared with 26% (28/106) in the vehicle group. In Study 2, the clearance rates were 24% (60/253) in the imiquimod cream group compared with 28% (35/126) in the vehicle group. These studies failed to demonstrate efficacy
The treatment of molluscum contagiosum with imiquimod cream is not recommended as the studies failed to demonstrate efficacy 2.
From the Research
Treatment Options for Molluscum Contagiosum
- The need for active treatment for molluscum contagiosum is controversial, but treatment is often indicated in cases of extensive disease, associated complications, or aesthetic complaints 3.
- Treatment options include mechanical, chemical, immunomodulatory, and antiviral methods 3.
- Physician-administered and patient-administered therapies are available, with novel patient-administered treatment options allowing for administration in the privacy of a patient's home 4.
- The pulsed dye laser has been shown to be a safe and effective treatment for molluscum contagiosum, with benefits including prompt response, fewer treatments, and minimal morbidity 5.
- Cantharidin is a practical treatment option for molluscum contagiosum, with detailed information available on distribution sources, application, and caveats regarding its use 6.
- Other treatment methods available for molluscum contagiosum include potassium hydroxide, salicylic acid, hydrogen peroxide, retinoids, cryotherapy, curettage, and pulsed dye laser 7.
Considerations for Treatment
- The decision to treat molluscum contagiosum should be based on individual patient needs, with consideration given to factors such as symptom severity, cosmetic concerns, and risk of transmission 4.
- Treatment should be selected based on the patient's specific condition, with consideration given to the potential benefits and risks of each treatment option 7.
- Watchful waiting can often be an appropriate management strategy for molluscum contagiosum, particularly in cases where the disease is mild and self-limiting 6.