From the Guidelines
Treatment for molluscum contagiosum should prioritize watchful waiting for mild cases, as the infection often resolves spontaneously within 6-12 months, and cryotherapy with liquid nitrogen or cantharidin for more severe or cosmetically bothersome cases, as these methods have shown similar efficacy in children 1.
Treatment Approaches
- Watchful waiting is a reasonable approach for mild cases, as resolution of uncomplicated molluscum contagiosum typically occurs spontaneously in 6 to 12 months 1.
- For active treatment, physical destruction methods such as cryotherapy with liquid nitrogen applied to each lesion for 5-10 seconds, or cantharidin (a blistering agent) applied by a healthcare provider to each lesion and washed off after 2-6 hours, are most common.
- Topical treatments, including imiquimod, have not shown significant benefit compared to placebo in randomized controlled trials 1.
Considerations
- Patients with underlying skin conditions, such as eczema, or those with cosmetically bothersome lesions, may benefit from treatment with 10% potassium hydroxide or cryotherapy with liquid nitrogen 1.
- Imiquimod was not shown to be of benefit compared with placebo in randomized controlled trials 1, and therefore should not be considered a first-line treatment.
- Cantharidin, although effective in some cases, has limited evidence supporting its use, and its effectiveness was not found to be statistically significant in a small randomized controlled trial 1.
Management
- During treatment, patients should avoid scratching lesions, cover affected areas during activities with skin-to-skin contact, and avoid sharing towels or personal items to prevent spread.
- 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.
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
The treatment for molluscum contagiosum with imiquimod cream failed to demonstrate efficacy in two randomized, vehicle-controlled, double-blind trials involving 702 pediatric subjects 2.
- Key points:
- Imiquimod cream was evaluated in pediatric subjects with molluscum contagiosum.
- The studies failed to demonstrate efficacy.
- The most frequently reported adverse reaction was application site reaction.
- Clinical decision: Due to the lack of demonstrated efficacy, imiquimod cream should not be considered a reliable treatment option for molluscum contagiosum 2, 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.
- A modified curettage technique has been described as an effective and well-tolerated treatment option for removing lesions of molluscum contagiosum 4.
- Cantharidin is a treatment option for molluscum contagiosum, which can be applied in a practical approach 5.
- Other treatment options include destructive therapies (curettage, cryotherapy, keratolytics), immunomodulators (imiquimod, cimetidine, Candida antigen), and antivirals (cidofovir) 5.
Special Considerations for Treatment
- Treatment approaches for molluscum contagiosum can vary widely, and there are no FDA-approved treatments available 6.
- Special considerations for treatment include atopic dermatitis, skin of color, and other factors that may affect treatment outcomes 6.
- Early diagnosis and treatment of molluscum contagiosum are important to reduce the risk of sexual transmission, prevent autoinoculation, and increase patient quality of life 7.
- Novel patient-administered treatment options are available, which can provide added convenience and reduce patient embarrassment or stress 7.
Treatment Guidelines and Algorithms
- There is a lack of clinical data from large, well-controlled studies, resulting in significant gaps in knowledge about treatment guidelines and algorithms for molluscum contagiosum 6.
- A review of treatment approaches and special considerations for molluscum contagiosum can provide practitioners with expert, evidence-based information and guidance 6.