eMedicine Specialties > Dermatology > Viral Infections
Molluscum Contagiosum: Treatment & Medication
Updated: Sep 1, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Molluscum contagiosum generally is self-limited and heals after several months or years. Any one lesion is present for about 2 months; however, to prevent autoinoculation or transmission to close contacts, therapy may be beneficial. The common goal of the different treatment methods is the destruction of the lesions. Controlled studies have not been completed with many of the various treatments. Commonly used treatments are not approved by the Food and Drug Administration (FDA).4
- Topical applications
- Cantharidin - A single application that may need to be repeated once or twice every 3-4 weeks; gained popularity since being placed on a special FDA Bulk Substances List in 1997, allowing cantharidin to be compounded and applied topically
- Tretinoin cream (0.1%) or gel (0.025%) - Applied daily
- Imiquimod cream 5%
- Trichloroacetic acid
- Cryotherapy with liquid nitrogen - One of the popular treatment modalities
- Systemic agents
- Children and infants
- In a study of efficacy, tolerability, and parental satisfaction with cantharidin treatment of children and infants aged 13 years and younger, 96% of subjects improved after treatment with cantharidin. Although 46% of patients experienced adverse events (9% classified as severe), including pain, pruritus, secondary infection, brisk immune response, and temporary hypopigmentation, the rate of parental satisfaction was 78%.7
- An open-label study has established the safety of imiquimod cream 5% 3 times per week for children with extensive molluscum contagiosum, although complete clearance of treated molluscum contagiosum lesions was not observed in any of the subjects after 4 weeks.8
- Recalcitrant molluscum contagiosum: The use of photodynamic therapy (PDT) with 20% 5-aminolevulinic acid (ALA) may be beneficial for patients with recalcitrant molluscum contagiosum.9 The technique has mainly been used for HIV-positive patients and immunocompromised children with molluscum contagiosum.
- Immunocompromised patients: The treatment success rate increases drastically with the use of antiviral medications, particularly HIV-1 protease inhibitors in combination with nucleoside analogs that inhibit reverse transcriptase. Improvement of lesions was seen in individual cases with the use of ritonavir, cidofovir (intravenous and topical), zidovudine, intralesional interferon alfa, and topical injections of streptococcal antigen OK-432.10,11,12,13,14
- Clinical guideline summaries
- British Association for Sexual Health and HIV - United Kingdom national guideline on the management of molluscum contagiosum15
- University of Texas, School of Nursing - Management of molluscum contagiosum16
Surgical Care
Curettage has been shown to be an effective treatment in children and adults.17 The topical anesthetic cream EMLA (eutectic mixture of local anesthetics) can be applied under occlusion an hour before curettage to decrease the discomfort associated with the procedure, but the area of application of the anesthetic should be limited (see manufacturer instructions).
Activity
Because molluscum contagiosum is known to spread by direct contact and fomites, patients need to be educated regarding transmission of the disease.
Medication
The goals of pharmacotherapy for molluscum contagiosum are to reduce morbidity and to prevent complications.
In immunocompromised patients with molluscum contagiosum, improvement of lesions was seen in individual cases with the use of ritonavir, cidofovir (intravenous and topical), AZT, intralesional interferon alpha, and topical injections of streptococcal antigen OK-432.
Cauterizing agents
Cause cornified epithelium to swell, soften, macerate, and then desquamate.
Cantharidin (Verr-Canth)
Effectiveness against warts may result from exfoliation. Lytic action does not affect basal layer and has minimal effect on the corium. Scarring does not occur.
Adult
Single application repeated once or twice q3-4wk
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; diabetes; impaired peripheral circulation; do not use on eyes, mucous membranes, anogenital or intertriginous areas, moles, birthmarks, or unusual warts with hair; do not use on lesions with other agents or if surrounding tissue is swollen or irritated
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Strong vesicant to be used sparingly
Trichloroacetic acid (Tri-Chlor)
Cauterizes skin, keratin, and other tissues. Although caustic, causes less local irritation and systemic toxicity than others in the same class. However, response is often incomplete and recurrence occurs frequently.
Adult
Paint onto lesions, avoid uninvolved skin; can be used in anal areas; repeat q1-2wk
Pediatric
Not established
None reported
Documented hypersensitivity; not for use on premalignant or malignant lesions; may cause hyperpigmentation or hypopigmentation
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
External use only; restrict use to treatment areas only
Silver nitrate
Coagulates cellular protein and remove granulation tissue.
Adult
Apply to affected area or lesion for approximately 5 d
Pediatric
Administer as in adults
Decreases effects of sulfacetamide preparations
Documented hypersensitivity; broken skin or cuts
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Not for internal use
Tincture of iodine
Cauterizes skin, keratin, and other tissues. Causes less local irritation than others in the same class.
Adult
Apply to affected area
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Not for application to open skin because it may be absorbed systemically
Retinoids
Regulate cell growth and proliferation.
Tretinoin (Avita, Retin-A)
Inhibits microcomedo formation and eliminates lesions present. Makes keratinocytes in sebaceous follicles less adherent and easier to remove.
Adult
Begin with lowest tretinoin formulation and increase as tolerated; apply hs or qod; lower frequency of application if irritation develops
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Toxicity increases with coadministration of benzoyl peroxide, salicylic acid, and resorcinol; avoid topical sulfur, resorcinol, salicylic acid, other keratolytics, abrasives, astringents, spices, and lime
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with excessive sunlight exposure; caution in eczema; do not apply to mucous membranes, mouth, and angles of nose
Histamine H2 antagonists
May improve symptoms when coadministered with other treatment modalities.
Cimetidine (Tagamet)
Histamine H2 receptor agonist. Treats itching, flushing, pruritus, urticaria, and contact dermatitis.
Adult
300-800 mg PO q6-8h; not to exceed 2400 mg/d
Pediatric
25-30 mg/kg/d PO divided q4h
Can increase blood levels of theophylline, warfarin, tricyclic antidepressants, triamterene, phenytoin, quinidine, propranolol, metronidazole, procainamide, and lidocaine
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Elderly persons may experience confusional states; may cause impotence and gynecomastia in young males; may increase levels of many drugs; adjust dose or discontinue treatment if changes in renal function occur
Immune response modifiers
Imiquimod (Aldara)
Induces secretion of cytokines, including interferon-alpha, TNF, and interleukins; increases T-cell activity. Minimal immediate antiviral activity. May be more effective in women than in men. Use 5% cream.
Adult
Apply 3 times/wk; not to exceed 16 wk; leave on skin 6-10 h
Pediatric
Administer as in adults; efficacy not demonstrated in children aged 2-12 y
None reported
Documented hypersensitivity; avoid natural and artificial sun exposure
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution with inflamed skin at site; avoid natural and artificial sun exposure; regarding genital use, not recommended for treatment of rectal, cervical, intravaginal, urethral, and intra-anal human papilloma virus infection; following surgery or drug treatment, do not use until genital/perianal tissue is healed; use with caution for immunocompromised patients, as safety and efficacy have not been established
More on Molluscum Contagiosum |
| Overview: Molluscum Contagiosum |
| Differential Diagnoses & Workup: Molluscum Contagiosum |
 Treatment & Medication: Molluscum Contagiosum |
| Follow-up: Molluscum Contagiosum |
| Multimedia: Molluscum Contagiosum |
| References |
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References
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Further Reading
Keywords
molluscum contagiosum, DNA poxvirus, MCV, molluscum contagiosum virus, MCV 1, MCV 2, selenoprotein, umbilicated papules, cryotherapy with liquid nitrogen, electrodesiccation
