Steroids Should NOT Be Used for Molluscum Contagiosum
Corticosteroids have no role in the treatment of molluscum contagiosum and are not recommended by any major guideline. There is no evidence supporting steroid use for this viral skin infection, and steroids could theoretically worsen the condition by suppressing local immune responses needed to clear the poxvirus.
Why Steroids Are Not Indicated
- Molluscum contagiosum is a benign, self-limited poxvirus infection that resolves through host immune response, typically within 6-12 months (though can persist up to 4-5 years) 1, 2
- The American Academy of Ophthalmology and American Academy of Pediatrics recommend physical removal methods (curettage, cryotherapy, excision) or topical chemical treatments (10% potassium hydroxide, cantharidin) as first-line therapies—steroids are not mentioned as a treatment option 1, 2, 3
- Watchful waiting is considered reasonable for asymptomatic, limited disease, as spontaneous resolution occurs naturally 2, 3
Evidence-Based Treatment Options
First-line physical removal methods include:
- Cryotherapy with liquid nitrogen (93% complete response rate) 1, 2
- Curettage, simple excision, or excision with cautery 2, 3
- 10% potassium hydroxide solution (similar efficacy to cryotherapy with better cosmetic results) 1, 2
- Cantharidin application (86% parent satisfaction in large retrospective review of 405 children) 1
Active treatment is indicated for:
- Symptomatic lesions causing pain, itching, or discomfort 2, 4
- Multiple lesions or extensive disease 2, 3
- Periocular lesions causing associated conjunctivitis 2, 3
- Prevention of autoinoculation and transmission to others 2, 4
Important Caveats
- Imiquimod should NOT be used—high-quality evidence shows no benefit compared to placebo in randomized controlled trials 1, 2, 5
- Salicylic acid is contraindicated in children under 2 years due to systemic toxicity risk 2
- Multiple large lesions with minimal inflammation should prompt evaluation for immunocompromised state 3
- Periocular lesions require physical removal and monitoring, as conjunctivitis may take weeks to resolve after lesion elimination 3
When Steroids ARE Mentioned in Guidelines
The only context where steroids appear in the provided evidence relates to completely different conditions (parasitic infections like neurocysticercosis, schistosomiasis, toxocariasis) where prolonged steroid courses are used 6. These guidelines specifically warn to exclude strongyloidiasis before steroid use due to hyperinfection risk 6. This has no relevance to molluscum contagiosum treatment.
Prevention and Transmission Control
- Hand hygiene with alcohol-based disinfectant or soap and water is the most important prevention method 2
- Avoid sharing towels, clothing, and personal items 2
- Cover all lesions with waterproof bandages if water exposure is unavoidable 2
- Limit exposure to swimming pools and hot tubs associated with known outbreaks 2