Can molluscum contagiosum be treated in pregnant women?

Treatment of Molluscum Contagiosum in Pregnancy

Yes, molluscum contagiosum can be safely treated during pregnancy using physical destruction methods, particularly cryotherapy, which is the preferred approach. 1

First-Line Treatment Approach

Physical procedures such as cryotherapy are safe to use throughout all trimesters of pregnancy for molluscum contagiosum. 1 This represents the most straightforward and evidence-based approach, as physical destruction avoids any systemic medication exposure to the developing fetus.

Recommended Physical Treatment Options:

• Cryotherapy with liquid nitrogen is the method of choice and can be safely performed at any point during pregnancy 1, 2
• Curettage is another safe physical option that directly removes the lesions 1, 2
• Cautery can be considered as an alternative physical destruction method 1

Medications to Avoid During Pregnancy

First Trimester - Critical Period:

• Avoid all topical chemical treatments including podophyllotoxin and imiquimod during the first trimester due to potential teratogenic concerns 1
• Systemic azole antifungals must be strictly avoided in the first trimester, as high-dose fluconazole has been associated with birth defects including craniosynostosis, characteristic facies, digital synostosis, and limb contractures 3, 4, 5

Throughout Pregnancy:

• Podophyllotoxin should be avoided throughout all trimesters due to insufficient safety data 1
• Imiquimod use requires caution and is generally not recommended during pregnancy 1, 6

Clinical Decision-Making Algorithm

For immunocompetent pregnant patients:

1. Offer cryotherapy as first-line treatment at any gestational age 1
2. If cryotherapy is not available or tolerated, curettage is an acceptable alternative 1
3. Watchful waiting is reasonable if lesions are minimal and patient preference supports observation 1, 7

For immunosuppressed pregnant patients:

• These patients develop severe and recalcitrant lesions that typically require more aggressive intervention 1
• Physical destruction remains the safest approach, though multiple treatment sessions may be necessary 1
• Consultation with infectious disease specialists is warranted for refractory cases 1

Important Clinical Considerations

Treatment is generally recommended rather than observation to reduce sexual transmission risk, prevent autoinoculation, and improve quality of life, particularly for genital lesions 7 The 2020 European guideline specifically addresses sexually transmitted molluscum and emphasizes that physical procedures are safe during pregnancy 1

Screen for other sexually transmitted infections in patients presenting with genital molluscum contagiosum, as co-infection is common 1

Common Pitfalls to Avoid

• Do not prescribe topical chemical agents (podophyllotoxin, imiquimod) without carefully considering pregnancy status and gestational age 1
• Do not assume spontaneous resolution will occur quickly - lesions may persist for 6 months to 5 years without treatment, and pregnancy does not accelerate clearance 6, 7
• Do not overlook the psychosocial impact - visible lesions carry social stigma and treating them improves patient quality of life even during pregnancy 7, 8