From the Guidelines
Treatment to remove molluscum contagiosum lesions is indicated in symptomatic patients, with options including incision and curettage, simple excision, excision and cautery, and cryotherapy. Molluscum contagiosum is a viral infection that can cause conjunctivitis and keratitis due to viral shedding from eyelid lesions onto the surface of the eye 1. The lesions may spontaneously resolve, but can also persist for months to years. In patients with multiple lesions, it is essential to identify and treat nascent lesions to reduce the risk of recurrence 1.
Key Considerations
- Molluscum contagiosum lesions can be treated with various methods, including incision and curettage, simple excision, excision and cautery, and cryotherapy 1.
- In adults, large and multiple molluscum lesions with relatively little conjunctival inflammation may indicate an immunocompromised state 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.
Treatment Approach
- The goal of treatment is to remove the lesions and reduce the viral load, allowing the host immunologic response to eliminate residual virus 1.
- Treatment options should be chosen based on the individual patient's needs and the severity of symptoms 1.
- It is crucial to consider the potential for immunocompromised states in adults with extensive or persistent lesions 1.
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 2.
- It is commonly found in pediatric populations, sexually active adults, and immunocompromised individuals 2, 3.
- The virus is primarily transmitted through direct contact with infected skin, which can be sexual, non-sexual, or autoinoculation 2.
Clinical Presentation and Diagnosis
- Clinically, MC presents as firm, rounded papules that are pink or skin-colored, with a shiny and umbilicated surface 2.
- The duration of the lesions can vary, but they are typically self-limited, resolving within 6-9 months 2, 4.
- Diagnosis is based on clinical findings, with dermoscopy being a useful clinical tool 2.
- If diagnostic doubt persists, confocal microscopy or skin biopsy may be performed 2.
Treatment Options
- The need for active treatment of MC is controversial, but it is generally recommended for cases of extensive disease, associated complications, or aesthetic complaints 2, 5.
- Treatment modalities include mechanical, chemical, immunomodulatory, and antiviral options 2, 4, 6.
- Cantharidin is a commonly used treatment option, which can be applied topically 4, 6.
- Other treatment options include cryotherapy, curettage, and immunomodulators such as imiquimod 5, 6.
Epidemiology and Considerations
- MC is a common viral infection that affects primarily pediatric patients, sexually active young adults, and immunocompromised people of all ages 3.
- The infection is often associated with atopic dermatitis and can have a significant impact on quality of life 3.
- There is a lack of established or FDA-approved first-line treatment for MC, which can contribute to a "benign neglect" attitude towards treatment 3.