From the Guidelines
Treatment for molluscum contagiosum should prioritize watchful waiting for many patients, especially children, as lesions often resolve spontaneously within 6-18 months, but active treatment options such as cryotherapy with liquid nitrogen or cantharidin application may be considered for cosmetically bothersome lesions or patients with underlying skin conditions. For patients with symptomatic molluscum contagiosum, treatment to remove the lesions is indicated, and options include incision and curettage, simple excision, excision and cautery, and cryotherapy 1. When considering treatment, it is essential to weigh the potential benefits against the risks, such as postinflammatory hyperpigmentation or scarring associated with cryotherapy 1. Key considerations in managing molluscum contagiosum include:
- Patient age and immune status
- Extent of infection
- Presence of underlying skin conditions, such as eczema
- Cosmetic concerns
- Risk of transmission and autoinoculation Some treatment options, such as imiquimod, have not shown significant benefit compared to placebo in randomized controlled trials 1. In contrast, cantharidin has been found to be effective in open-label and observational studies, although its efficacy in randomized controlled trials is less clear 1. Overall, the approach to treating molluscum contagiosum should be individualized, taking into account the specific needs and circumstances of each patient, and prioritizing strategies that minimize morbidity, mortality, and impact on quality of life.
From the FDA Drug Label
1.4 Limitations of Use Imiquimod cream has been evaluated in children ages 2 to 12 years with molluscum contagiosum and these studies failed to demonstrate efficacy. The FDA drug label does not support the use of imiquimod cream as a treatment for molluscum contagiosum, as studies in children ages 2 to 12 years failed to demonstrate efficacy 2.
From the Research
Treatment Options for Molluscum Contagiosum
- The need for active treatment for molluscum contagiosum is controversial, but treatment is often indicated in cases of extensive disease, associated complications, or aesthetic complaints 3.
- Several treatment modalities are available, including mechanical, chemical, immunomodulatory, and antiviral treatments 3, 4, 5, 6, 7.
- Mechanical treatments include curettage, cryotherapy, and pulsed dye laser therapy 4, 5, 7.
- Chemical treatments include cantharidin, potassium hydroxide, podophyllotoxin, benzoyl peroxide, tretinoin, trichloroacetic acid, lactic acid, glycolic acid, and salicylic acid 4, 5, 7.
- Immunomodulatory treatments include imiquimod, interferon-alpha, and cimetidine 4, 7.
- Antiviral treatments include cidofovir 4, 6, 7.
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 7.
- Treatment options may also be influenced by the presence of underlying conditions, such as atopic dermatitis or immunosuppression 4, 6.
- Watchful waiting may be an appropriate management strategy for some patients, particularly those with mild disease or who are asymptomatic 3, 7.
Special Considerations
- Patients with weakened immune systems may require more aggressive treatment, as they are at increased risk of complications and prolonged disease duration 3, 6.
- Treatment of genital molluscum contagiosum lesions is often recommended to reduce the risk of sexual transmission and improve patient quality of life 6.