From the Guidelines
Pediatric molluscum contagiosum treatment should prioritize watchful waiting, as the condition often resolves spontaneously within 6-12 months, and treatment options like cryotherapy with liquid nitrogen or 10% potassium hydroxide can be considered for cosmetically bothersome lesions or those in patients with underlying skin conditions. When considering treatment, the following options can be evaluated:
- Cryotherapy with liquid nitrogen, which appears to have similar efficacy to 10% potassium hydroxide in children, but may be associated with postinflammatory hyperpigmentation or scarring 1
- 10% potassium hydroxide, which has been used to treat lesions that are cosmetically bothersome or in patients with underlying skin conditions such as eczema 1
- Cantharidin, which has shown promise in open-label and observational studies, but its effectiveness is not statistically significant in randomized controlled trials 1 It is essential to advise parents that molluscum contagiosum is contagious through direct contact and can autoinoculate to other body areas, and children can attend school normally but should avoid sharing towels, clothing, or bath water. Treatment is particularly recommended for lesions in the genital area, face, or those causing discomfort, as well as in immunocompromised children. The goal of treatment is to stimulate the immune response or physically remove infected tissue, and the choice of treatment should be individualized based on the patient's specific needs and circumstances.
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 Adverse events which occurred more frequently in Imiquimod-treated subjects compared with vehicle-treated subjects generally resembled those seen in studies in indications approved for adults and also included otitis media (5% imiquimod vs. 3% vehicle) and conjunctivitis (3% imiquimod vs. 2% vehicle).
The safety and efficacy of Imiquimod Cream for molluscum contagiosum in patients have been evaluated in two studies, but these studies failed to demonstrate efficacy. The most frequently reported adverse reaction was application site reaction. Adverse events that occurred more frequently in Imiquimod-treated subjects included otitis media and conjunctivitis.
- Key points:
- Imiquimod cream was evaluated in two randomized trials involving 702 pediatric subjects with molluscum contagiosum.
- The studies failed to demonstrate efficacy.
- The most frequently reported adverse reaction was application site reaction.
- Adverse events that occurred more frequently in Imiquimod-treated subjects included otitis media and conjunctivitis. 2
From the Research
Treatment Options for Pediatric Molluscum Contagiosum
- Cantharidin is a commonly used treatment option for molluscum contagiosum, with 92% of respondents reporting satisfaction with its efficacy 3
- Imiquimod is also an effective and safe treatment option, with 73.91% of children showing complete remission within 3 to 8 weeks of treatment 4
- Other treatment options include curettage, cryotherapy, and keratolytics, among others 5, 6
- Benign neglect, or watchful waiting, can also be an appropriate management strategy, especially for children with mild cases of molluscum contagiosum 5, 7
Considerations for Treatment
- The decision to treat molluscum contagiosum should be based on the individual child's needs and circumstances, including the presence of symptoms, comorbidities, and the risk of transmission to others 5, 7
- Treatment should aim to reduce symptoms, prevent spread, and promote disease remission 7
- The choice of treatment should take into account the potential side effects and risks associated with each option, such as discomfort, pain, and blistering with cantharidin 3