What are the treatment options for Molluscum contagiosum?

From the Guidelines

Molluscum contagiosum treatment should prioritize watchful waiting for mild cases, as the infection often resolves on its own within 6-12 months, while cryotherapy with liquid nitrogen or cantharidin application can be considered for more severe or cosmetically bothersome cases. The approach to treatment depends on the severity of the infection and patient preference. For mild cases, watchful waiting is a reasonable approach, given that the infection often resolves spontaneously within 6-12 months, although it may take up to 4 years for complete resolution of lesions 1.

Treatment Options

• Cryotherapy with liquid nitrogen: applied every 2-3 weeks until resolution, which appears to have similar efficacy to 10% potassium hydroxide in children, but may be associated with postinflammatory hyperpigmentation or scarring 1.
• Cantharidin application: a blistering agent applied by healthcare providers, which has shown effectiveness in open-label and observational studies, although its efficacy was not found to be statistically significant in a small randomized controlled trial 1.
• Physical destruction methods: including curettage (scraping lesions off with a curette after local anesthesia) or excision and cautery, which can be effective in removing the lesions and reducing the risk of recurrence 1.

Prevention of Spread

To prevent the spread of molluscum contagiosum, it is essential to:

• Avoid scratching lesions
• Not share towels or clothing
• Cover lesions when possible
• Avoid sexual contact if lesions are in the genital area

These measures can help reduce the transmission of the virus and prevent further complications. The most recent and highest quality study 1 supports the use of treatment options that remove the lesions, such as cryotherapy or cantharidin application, to reduce the risk of recurrence and promote resolution of the infection.

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

Molluscum contagiosum treatment with imiquimod cream is not effective, as shown in two randomized, vehicle-controlled, double-blind trials involving 702 pediatric subjects 2 and 2.

• The complete clearance rate was 24% in the imiquimod cream group compared with 26% in the vehicle group in Study 1.
• In Study 2, the clearance rates were 24% in the imiquimod cream group compared with 28% in the vehicle group. Imiquimod cream has been evaluated in children ages 2 to 12 years with molluscum contagiosum and these 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 modalities include mechanical, chemical, immunomodulatory, and antiviral options 3.
• Physician-administered and patient-administered therapies are available, with novel patient-administered treatment options providing added convenience and reducing patient embarrassment or stress 4.
• Cantharidin is a treatment option for Molluscum contagiosum, which can be used as a first-line treatment approach for those needing treatment 5.
• Imiquimod, a topically applicable Toll-like receptor (TLR)-7/8 agonist, has been shown to be effective and safe in the treatment of Molluscum contagiosum in children, with a complete remission rate of 73.91% in one study 6.
• New developing treatments, such as VP-102 (a standardized preparation of topical cantharidin) and SB206 (a topical nitric oxide-releasing product), have shown promising results in terms of safety and efficacy in large cohorts of patients in phase III studies and may become the first FDA-approved therapies for the treatment of Molluscum contagiosum 7.

Considerations for Treatment

• The decision to treat Molluscum contagiosum should be based on individual patient needs, taking into account the extent of the disease, associated complications, and aesthetic concerns 3, 4.
• Treatment options should be chosen based on their efficacy, safety, and potential for scarring or other adverse effects 4, 5.
• Patient-administered treatments can provide added convenience and reduce patient embarrassment or stress, but may require careful instruction and monitoring to ensure proper use 4.
• The use of imiquimod in the treatment of Molluscum contagiosum in children has been shown to be effective and safe, but may require careful consideration of potential adverse effects, such as mild to moderate irritation at the application site 6.