How is therapeutic trauma used to treat 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

Varying degrees of physical trauma to individual lesions are used and are frequently quite successful. Physical trauma to individual molluscum contagiosum lesions can be performed with cryotherapy, lasers, curettage, [48, 49] expression of the central core with tweezers, rupture of the central core with a needle or a toothpick, [50, 51] electrodesiccation, shave removal, or duct tape occlusion. [52]

Instruct the parents to tease out the firm, white core at the center of lesions using a clean needle or a toothpick. The process of irritating the lesion usually causes it to inflame and resolve within 1-2 weeks. This safe and easy approach can be performed by the patient's parent, limiting the need for follow-up visits.

In an office setting, curettage of individual lesions is easy and very effective. With a sharp curette and a quick firm motion, small, individual lesions can be removed completely, with little or no bleeding. With practice and a sharp curette, the provider may perform this procedure with little or no discomfort. Older children, adolescents, and adults usually tolerate this procedure better.

Other simple mechanical methods, such as expression of the contents in the papule by squeezing it with forceps held parallel to the skin surface or shaving off the lesions with a sharp scalpel, are effective.

Lesions may also be treated with light electrodesiccation. At very low voltage settings, anesthesia may not be required.

Cryotherapy is the first-line treatment for many physicians, particularly in adolescents and adults. A brief freeze, which causes icing of the lesion and a thin rim of surrounding skin, is usually adequate. Treatment is repeated at intervals of 2-3 weeks until all lesions resolve. Achieve accurate spray of liquid nitrogen by using a disposable ear speculum. The small end is placed against the skin, and liquid nitrogen is sprayed into the funnel created. Lesions also may be treated with cotton-tip applicators chilled in liquid nitrogen and held against the lesion until a small amount of frosting occurs. Cryotherapy is painful and the smoke that rises off the cold applicator or the noise of the liquid nitrogen sprayer may be quite frightening to younger children.

Pulsed dye laser (PDL) therapy has been shown to be more than 95% successful in treating individual lesions with 1 treatment. PDL treatment of molluscum contagiosum has been used successfully in patients with AIDS. A significant reduction in the number of molluscum contagiosum lesions following a single treatment with the PDL can be attained. Treated areas may remain disease-free for months. Although cost and availability are major limiting factors for routine use, PDL therapy may be considered for treatment of extensive or resistant lesions. It may also be valuable in immunocompromised individuals with extensive disease. [53, 54, 55, 56, 57]

Treatment of molluscum contagiosum in patients with AIDS remains a challenge. The combination of 2 or more therapeutic modalities, such as carbon dioxide laser, PDL, and trichloroacetic acid, can be of much help to improve the quality of life of these patients.

The discomfort of curettage or other mechanical removal may be reduced. Lesions may be sprayed with ethyl chloride until frosting has occurred and then scraped away with a curette. The application of local anesthetic cream, EMLA (a eutectic mixture of 5% lignocaine and prilocaine) or its equivalent, may permit painless treatment. The cream is best applied under occlusion 1-2 hours before the planned procedure.


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