Availability of 10% Potassium Hydroxide Solution in Pharmacies
A 10% potassium hydroxide (KOH) solution is NOT readily available as a standard over-the-counter or pre-made prescription product in most pharmacies and must be compounded by a pharmacist for specific patient use. 1
Compounding Requirements
- KOH solutions require custom preparation by a licensed pharmacist, similar to other specialized topical formulations like boric acid gelatin capsules and flucytosine cream used for resistant infections 1
- The solution must be specifically compounded for individual patient use rather than purchased as a ready-made product 1
- This is distinct from the diagnostic KOH preparations used in laboratories for microscopy, which are not formulated for therapeutic topical application 1, 2
Clinical Context for Molluscum Contagiosum
While 10% KOH is recommended as a treatment option for molluscum contagiosum in children over 2 years old, the American Academy of Pediatrics notes that:
- Resolution typically occurs spontaneously in 6-12 months without treatment, though complete clearing can take up to 4 years 1
- Treatment is primarily indicated for lesions that are cosmetically bothersome or in patients with underlying skin conditions like eczema 1
- 10% KOH and cryotherapy with liquid nitrogen have similar efficacy in children, though cryotherapy may cause postinflammatory hyperpigmentation or scarring 1
Research Evidence on Efficacy
Multiple randomized controlled trials demonstrate that compounded 10% KOH is effective when available:
- Complete clearance rates of 55-92.5% have been reported with 10% KOH versus 16-19% with placebo 3, 4, 5
- Mean treatment duration is approximately 30 days when applied once or twice daily 5, 6
- Local side effects (stinging, inflammation, hypopigmentation) occur in 32-72% of patients but are generally mild and resolve completely in 91.5% of cases 3, 5
Practical Considerations
The need for compounding creates a significant barrier to access that clinicians should anticipate when prescribing this treatment. You will need to:
- Contact the pharmacy in advance to confirm their ability to compound the solution 1
- Allow additional time (often 24-48 hours) for preparation
- Expect higher costs compared to standard prescription medications due to compounding fees
- Consider alternative treatments like cryotherapy if compounding services are unavailable in your area 1