Is 10% Potassium Hydroxide Available Through Prescription?
Yes, 10% potassium hydroxide (KOH) solution is available by prescription and is recommended by the American Academy of Pediatrics as a first-line chemical treatment for molluscum contagiosum in children, with efficacy similar to cryotherapy (86.6% complete response rate). 1, 2
Prescription Status and Clinical Use
10% KOH aqueous solution is a prescription medication that must be compounded by a pharmacy, as it is not available as an FDA-approved commercial product for molluscum contagiosum treatment 3
The American Academy of Pediatrics explicitly recommends 10% potassium hydroxide solution as a topical chemical treatment option for molluscum contagiosum, confirming its status as a legitimate prescription therapy 1, 2
Multiple randomized controlled trials have demonstrated that 10% KOH is superior to placebo (55.3% vs 16.3% cure rate, p < .001) and achieves complete clinical cure in approximately 86.6% of patients 4, 5
Application Protocol
The solution is applied once or twice daily directly to each molluscum lesion until inflammation and superficial ulceration occur, typically requiring a mean treatment period of 30 days 3
Treatment should continue until all lesions undergo controlled inflammation and clearing, with maximum treatment duration typically set at 30 days in clinical trials 4
Parents or patients apply the solution at home, making it a practical outpatient treatment option that avoids the need for repeated office visits 3, 6
Safety Profile and Side Effects
Common adverse events include stinging and burning sensation (occurring in 72.3% of patients), erosions, and post-inflammatory hypo- or hyperpigmentation, though most patients (91.5%) completely recover 4, 7
No severe adverse events have been reported in large case series, and the treatment is considered safe for children aged 2 years and older 4, 3
10% KOH confers better cosmetic results compared to cryotherapy due to lower risk of postinflammatory hyperpigmentation and scarring 1, 2
Important Clinical Considerations
Salicylic acid (not KOH) is contraindicated in children under 2 years due to risk of systemic toxicity, but 10% KOH has been safely used in children as young as 2 years 2, 4
For periocular lesions causing conjunctivitis, physical removal methods are preferred over chemical treatments to ensure rapid resolution of ocular complications 1, 2
Higher concentrations (15-20% KOH) have been studied, with 20% KOH twice daily showing faster clearing (7-20 days) but similar side effect profiles 7, 6
Comparison to Other Diagnostic Uses
- While 10% KOH is commonly used as a diagnostic tool for fungal infections (to digest epithelial debris and visualize fungal elements), its therapeutic use for molluscum contagiosum represents a distinct prescription indication 8