From the Guidelines
Topical treatment with cantharidin is the most effective option for molluscum contagiosum, despite the lack of statistically significant evidence, due to its efficacy shown in open-label and observational studies. When considering treatment options, it's essential to weigh the potential benefits and risks, particularly in terms of morbidity, mortality, and quality of life. In the case of molluscum contagiosum, the primary concern is often cosmetic, as the lesions can be bothersome to patients, especially those with underlying skin conditions like eczema 1.
Treatment Options
- Cantharidin: applied by healthcare providers, causes blistering of the lesions, and is left on for 2-6 hours before washing off
- Cryotherapy with liquid nitrogen: may be associated with postinflammatory hyperpigmentation or scarring, and has similar efficacy to 10% potassium hydroxide in children 1
- Imiquimod: not shown to be of benefit compared with placebo in randomized controlled trials 1
- 10% potassium hydroxide: used to treat lesions that occur in locations that are cosmetically bothersome to patients or for patients with underlying skin conditions such as eczema 1
Considerations
- Resolution of uncomplicated molluscum contagiosum typically occurs spontaneously in 6 to 12 months, although complete resolution of lesions can take up to 4 years 1
- Treatment should be individualized, taking into account the patient's preferences, skin type, and potential risks associated with each treatment option
- It's crucial to apply topical treatments only to the lesions and not surrounding skin, and to continue treatment until all lesions have resolved, which may take several weeks to months.
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
- Topical treatment: Imiquimod cream has been evaluated for the treatment of molluscum contagiosum, but the studies failed to demonstrate efficacy 2.
- Adverse reactions: The most frequently reported adverse reaction was application site reaction 2.
- Key points:
- Imiquimod cream is not recommended for the treatment of molluscum contagiosum due to lack of efficacy.
- The cream may cause application site reactions.
From the Research
Topical Treatments for Molluscum Contagiosum
- Topical imiquimod has been shown to be an effective and safe treatment for molluscum contagiosum in children, with a complete remission rate of 73.91% in one study 3.
- Cantharidin is another topical treatment option for molluscum contagiosum, with studies demonstrating its efficacy and safety in pediatric patients 4, 5, 6.
- The efficacy of topical cantharidin for molluscum contagiosum has been variable, with clearance rates ranging from 15.4-100% 6.
- Topical cantharidin has also been shown to be effective in combination with other treatments, such as podophyllotoxin and salicylic acid, for the treatment of warts 6.
- Other topical treatment options for molluscum contagiosum include potassium hydroxide, podophyllotoxin, benzoyl peroxide, tretinoin, trichloroacetic acid, lactic acid, glycolic acid, and salicylic acid 7.
- Imiquimod, an immune-modulating treatment, has also been used to treat molluscum contagiosum, with some studies demonstrating its efficacy and safety 3, 7.