What is the basis for treatment selection in molluscum contagiosum?

Updated: Aug 09, 2018
  • Author: Ashish C Bhatia, MD, FAAD, FACMS; Chief Editor: Dirk M Elston, MD  more...
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Answer

The most appropriate therapeutic approach largely depends on the clinical situation. In healthy children, a major goal is to limit discomfort, and benign neglect or minor, direct lesional trauma is appropriate. In adults who are more motivated to have their lesions treated, cryotherapy or curettage of individual lesions is effective and well tolerated.

In immunocompromised individuals, molluscum contagiosum may be very extensive and difficult to treat. The goal may be to treat the most troublesome lesions only. In severe cases, these patients may warrant more aggressive therapy with lasers, antiviral therapy, or a combination of these. [26] Of course, effective antiretroviral therapy in patients with AIDS makes therapy of molluscum contagiosum much more effective.

The US Food and Drug Administration (FDA) has approved none of the topical or intralesional agents for treatment of molluscum contagiosum.

In a study of the treatment of molluscum contagiosum in children, Hanna et al determined that curettage was the most efficacious therapy. The investigators conducted a prospective, randomized trial that compared the efficacy and adverse effects of four previously recognized treatments for molluscum contagiosum in 124 children. [27] One group was treated with curettage, a second with cantharidin, a third with a combination of salicylic acid and lactic acid, and a fourth with imiquimod.

Curettage was found to be the most efficacious treatment and had the lowest rate of adverse effects. However, it must be performed with adequate anesthesia and is a time-consuming procedure. Cantharidin is generally well tolerated, but this study had moderate complications owing to blisters and was slightly less effective. The topical keratolytic used was too irritating for children. Topical imiquimod has been found to be ineffective in several studies, and combination therapy may be required. [28, 29, 30, 31, 32, 33]


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