From the Guidelines
Molluscum contagiosum treatment should prioritize cryotherapy with liquid nitrogen or cantharidin application for effective lesion removal, considering the potential for spontaneous resolution within 6-12 months. When deciding on a treatment approach, it's crucial to weigh the benefits and risks, including the potential for postinflammatory hyperpigmentation or scarring associated with cryotherapy 1. The choice between cryotherapy and cantharidin may depend on the patient's specific condition, including the location and number of lesions, as well as any underlying skin conditions such as eczema.
Treatment Options
- Cryotherapy with liquid nitrogen: Applied every 2-3 weeks until resolution, this method directly destroys the virus-infected tissue.
- Cantharidin application: Although its efficacy compared to placebo has shown mixed results in randomized controlled trials, open-label and observational studies suggest it can be an effective treatment for molluscum contagiosum 1.
- Watchful waiting: For mild cases, given that the infection often resolves on its own within 6-12 months, though it may take up to 4 years for complete resolution of lesions.
Considerations
- The potential for spontaneous resolution and the duration of the disease should be considered when deciding on the treatment approach.
- Good hygiene practices are essential during treatment to prevent the spread of the infection, including avoiding direct skin contact with affected areas and covering lesions when possible.
- For patients with symptomatic conjunctivitis due to molluscum contagiosum, treatment to remove the lesions is indicated, and options include incision and curettage, simple excision, excision and cautery, and cryotherapy 1.
Recent Evidence
The most recent study from 2024 1 emphasizes the importance of treating symptomatic patients to prevent complications such as conjunctivitis and keratitis, highlighting the need for a proactive approach in managing molluscum contagiosum, especially in cases involving the eye.
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 Similar to the studies conducted in adults, the most frequently reported adverse reaction from 2 studies in children with molluscum contagiosum was application site reaction
The treatment of molluscum contagiosum with imiquimod cream failed to demonstrate efficacy in two randomized, vehicle-controlled, double-blind trials involving 702 pediatric subjects 2.
- The most frequently reported adverse reaction was application site reaction.
- Imiquimod cream is not recommended for the treatment of molluscum contagiosum due to lack of efficacy 2.
From the Research
Molluscum Contagiosum Treatment Options
Molluscum contagiosum is a common skin infection caused by a poxvirus, typically affecting children and immunocompromised individuals. The infection usually resolves on its own, but treatment may be preferred for social and cosmetic reasons or to prevent transmission.
- Treatment options for molluscum contagiosum include:
- Mechanical methods: cryotherapy, curettage, pulsed dye laser therapy
- Chemical methods: cantharidin, potassium hydroxide, podophyllotoxin, benzoyl peroxide, tretinoin, trichloroacetic acid, lactic acid, glycolic acid, salicylic acid
- Immune-modulating methods: imiquimod, interferon-alpha, cimetidine
- Anti-viral methods: cidofovir
Imiquimod as a Treatment Option
Imiquimod is a topical cream that has been used to treat molluscum contagiosum. Studies have shown that imiquimod can be effective in treating the infection, particularly in children.
- A study published in 2017 found that topical imiquimod was effective and safe in treating molluscum contagiosum in children, with 73.91% of patients achieving complete remission within 3 to 8 weeks of treatment 3.
- Another study published in 2000 found that imiquimod was effective in treating molluscum contagiosum in children and adults, with 14 out of 19 immune-competent adults and 6 out of 13 children achieving resolution of their lesions within 16 weeks of treatment 4.
- A case series published in 2004 found that combination therapy with cantharidin and imiquimod was effective and well-tolerated in treating molluscum contagiosum in children, with 12 out of 16 patients achieving >90% clearance of lesions 5.
Comparison of Treatment Options
A systematic review published in 2017 found that there was no single intervention that was convincingly effective in treating molluscum contagiosum, and that the natural resolution of the infection remained a strong option for dealing with the condition 6.
- The review found that topical 5% imiquimod was no more effective than vehicle in terms of clinical cure, but led to more application site reactions.
- The review also found that other treatment options, such as cryospray, potassium hydroxide, and benzoyl peroxide, may be more effective than imiquimod in achieving short-term clinical cure.
Recent Patents and Updates
Recent patents related to the management of molluscum contagiosum include topical compositions and herbal Chinese medicine, although the efficacy of these treatments is limited 7.
- A review published in 2017 found that the choice of treatment method should depend on the physician's comfort level with the various treatment options, the patient's age, the number and severity of lesions, location of lesions, and the preference of the child/parents.