What is the diagnosis and treatment for molluscum contagiosum?

From the Guidelines

Molluscum contagiosum is typically a self-limiting disease that resolves spontaneously within 6-12 months, and treatment is usually not necessary unless the lesions are cosmetically bothersome or occur in patients with underlying skin conditions. The management of molluscum contagiosum involves several treatment options, including cryotherapy with liquid nitrogen, 10% potassium hydroxide, and cantharidin, although the efficacy of these treatments varies 1. Some key points to consider in the management of molluscum contagiosum include:

• Cryotherapy and 10% potassium hydroxide have similar efficacy in children, but cryotherapy may be associated with postinflammatory hyperpigmentation or scarring 1.
• Imiquimod has not been shown to be of benefit compared with placebo in randomized controlled trials 1.
• Cantharidin may be an effective treatment for molluscum contagiosum, but its efficacy is not consistently supported by randomized controlled trials 1.
• In patients with conjunctivitis and keratitis 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.
• Follow-up is not usually necessary unless the conjunctivitis persists, and referral to a dermatologist may be necessary for examination of other suspicious lesions 1. The most effective treatment approach for molluscum contagiosum should be individualized based on the patient's symptoms, underlying health status, and preferences, and should prioritize minimizing morbidity, mortality, and improving quality of life 1.

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 Imiquimod cream has been evaluated in children ages 2 to 12 years with molluscum contagiosum and these studies failed to demonstrate efficacy.

Molluscum contagiosum treatment with imiquimod cream has been evaluated in two studies, but efficacy was not demonstrated in children aged 2-12 years 2, 2, and 2. The most common adverse reaction was application site reaction.

From the Research

Overview of Molluscum Contagiosum

• Molluscum contagiosum (MC) is a self-limited infectious dermatosis caused by the molluscum contagiosum virus (MCV), a member of the Poxviridae family 3.
• It is commonly found in pediatric populations, sexually active adults, and immunocompromised individuals.
• The virus is primarily transmitted through direct contact with infected skin, which can be sexual, non-sexual, or autoinoculation.

Clinical Presentation

• Clinically, MC presents as firm, rounded papules that are pink or skin-colored, with a shiny and umbilicated surface 3.
• The duration of the lesions can vary, but they are typically self-limited, resolving within 6-9 months in most cases.
• The skin lesions can vary in size, shape, and location, and may be more frequent in immunosuppressed patients, potentially leading to complications such as eczema and bacterial superinfection.

Diagnosis

• The diagnosis of MC is based on clinical findings, with dermoscopy being a useful clinical tool 3.
• If diagnostic doubt persists, confocal microscopy or skin biopsy may be performed to confirm the diagnosis.

Treatment

• The need for active treatment of MC is controversial, but treatment is generally recommended in cases of extensive disease, associated complications, or aesthetic complaints 3, 4.
• Various treatment modalities are available, including mechanical, chemical, immunomodulatory, and antiviral approaches 3, 4, 5.
• Cantharidin is one treatment option that has been discussed in the literature as a practical approach for treating MC 4.
• A review of therapeutic approaches and special considerations for treating MC highlights the lack of FDA-approved treatments and the variability in treatment approaches among healthcare practitioners 5.

Treatment Efficacy

• A systematic review of interventions for cutaneous MC found that no single intervention has been shown to be convincingly effective in treating the condition 6.
• Topical 5% imiquimod was found to be no more effective than vehicle in terms of clinical cure, but led to more application site reactions 6.
• The review also found that there is limited evidence to support the use of various other treatments, including cryospray, potassium hydroxide, and benzoyl peroxide cream 6.

Importance of Early Diagnosis and Treatment

• Early diagnosis and treatment of MC are important to reduce the risk of sexual transmission, prevent autoinoculation, and improve patient quality of life 7.
• Treatment options for MC include physician-administered and patient-administered therapies, with novel patient-administered treatment options providing added convenience and reducing patient embarrassment or stress 7.