From the Guidelines
Molluscum contagiosum treatment should prioritize physical removal methods, including cryotherapy, curettage, or cantharidin application, as they are the most effective approaches, especially for symptomatic patients. The decision to treat should consider the severity of the infection, patient preference, and the potential for spontaneous resolution, which typically occurs within 6-12 months, though it may take up to 4 years 1.
Treatment Options
- Physical removal methods:
- Cryotherapy with liquid nitrogen
- Curettage (scraping off lesions)
- Cantharidin application (a blistering agent applied by healthcare providers)
- Topical treatments:
- Potassium hydroxide 10% solution applied twice daily until lesions resolve
- Note: Imiquimod was not shown to be of benefit compared with placebo in randomized controlled trials 1
Considerations
- The virus infects the epidermis, causing characteristic dome-shaped papules with central umbilication.
- Treatment works by triggering an immune response or physically removing infected tissue.
- Since molluscum is highly contagious, it's essential to avoid sharing towels, clothing, or bath water, and cover lesions when possible to prevent spread.
- For patients with multiple lesions, care should be taken to identify and treat nascent lesions to reduce the risk of recurrence, as reduction of the viral load often allows the host immunologic response to eliminate residual virus 1.
Recent Guidelines
The most recent guidelines from 2024 suggest that treatment to remove the lesions is indicated in symptomatic patients, with options including incision and curettage, simple excision, excision and cautery, and cryotherapy 1. Given the recency and quality of this study, its recommendations should be prioritized in clinical practice.
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.
- 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 of molluscum contagiosum is controversial, but it is generally indicated in cases of extensive disease, associated complications, or aesthetic complaints 3.
- Treatment modalities include mechanical, chemical, immunomodulatory, and antiviral options 3, 4, 5, 6.
- Mechanical treatments include curettage, cryotherapy, and laser ablation 4, 5, 6.
- Chemical treatments include salicylic acid, glycolic acid, tretinoin, and cantharidin 4, 5, 6.
- Immunomodulatory treatments include imiquimod and cimetidine 4, 7, 6.
- Antiviral treatments include cidofovir 7, 6.
Efficacy of Treatment Options
- There is no single treatment that has been shown to be convincingly effective in the treatment of molluscum contagiosum 7.
- Topical 5% imiquimod has been found to be no more effective than vehicle in terms of clinical cure, but leads to more application site reactions 7.
- Cantharidin has been found to be effective in treating molluscum contagiosum, but its use requires caution due to potential side effects 5, 6.
- Cryotherapy with liquid nitrogen is a commonly used treatment option, but its efficacy has not been well established in clinical trials 6.
Considerations for Treatment
- 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 6.
- Watchful waiting is also a viable option, as molluscum contagiosum is a self-limited disease that can resolve on its own within 6-9 months 3, 6.