eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Molluscum Contagiosum: Treatment & Medication

Author: Ashish C Bhatia, MD, FAAD, Assistant Professor of Clinical Dermatology, Department of Dermatology, Northwestern University, Feinberg School of Medicine; Director of Clinical Research, Department of Dermatology and Dermatologic Surgery, River North Dermatology and Dermatologic Surgery, DuPage Medical Group
Coauthor(s): Tracy Campbell, MD, Staff Physician, Department of Dermatology, Rush Medical Center; Seth Forman, MD, Department of Dermatology, Medical College of Virginia; David Rowe, MD, Pathologist, Laboratory Medicine, Martha Jefferson Hospital; Robert Orenstein, DO, Associate Professor, Department of Medicine, Medical College of Virginia, Virginia Commonwealth University; Medical Director, Infectious Disease Clinic, Medical College of Virginia Hospitals; Julia R Nunley, MD, Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center
Contributor Information and Disclosures

Updated: Apr 1, 2008

Treatment

Medical Care

The course of molluscum contagiosum usually is self-limited, and lesions generally heal without scarring.

Intervention may be indicated if lesions persist. Therapeutic modalities include topical application of various medications, radiation therapy, and/or surgery. Each technique might result in scarring or postinflammatory pigmentary changes. Frequently, multiple treatment sessions are necessary because of the recurrence of treated lesions and/or the appearance of new lesions by autoinoculation. The benefit of therapy must exceed the risk.

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

  • Topical therapy: Clinical success has been reported with the use of the following topical agents, which may act as irritants, stimulating an immunological response.  
    • Imiquimod cream is an immune response modifier approved for the treatment of external genital and perianal warts in adults. It has been reported to be effective in the treatment of molluscum contagiosum.7,38 Imiquimod cream may be used in conjunction with cantharidin.33
    • Several studies report that cantharidin, a chemovesicant, is effective in treating molluscum contagiosum. To test the patient's response to therapy, treat only a few lesions on the initial visit. Cantharidin may be used in combination with imiquimod.33
    • Tretinoin has reportedly been successful in the treatment of small molluscum contagiosum lesions. Tretinoin, cantharidin, and imiquimod may be dispensed to the patient with application instructions and close follow-up.
    • Bichloracetic acid, trichloroacetic acid, salicylic acid, lactic acid, glycolic acid, and silver nitrate also have been used, but the physician must apply them in the office.
    • Topical podophyllotoxin 0.5% cream self-administered twice daily for 3 weeks has been reported effective in one placebo-controlled, double-blind study.37
  • Reports have suggested that subcutaneous interferon alfa (IFN-alfa) administered intralesionally may be useful in immunocompromised children.
  • A recent case report noted the efficacy of topical cidofovir in the treatment of disseminated molluscum in immunodepressed patients.14 Cidofovir diphosphate was reported to inhibit molluscum contagiosum virus DNA polymerase activity.39

Surgical Care

Frequently, multiple treatment sessions are necessary because of recurrence of treated lesions and/or the appearance of new lesions by autoinoculation. Each technique may result in scarring or postinflammatory pigment changes.

  • Curettage: Individual lesions may be removed with a hand-held curette, with little discomfort. Follow curettage with application of a topical irritant.
  • Cryosurgery: Apply liquid nitrogen for 10-15 seconds per lesion. Liquid nitrogen therapy may be painful and can result in blistering. Temporary or permanent depigmentation may occur in individuals who are more darkly pigmented.
  • Electrodesiccation may be used for lesions that are refractory to curettage or cryosurgery. This technique can cause significant discomfort; consider using local anesthesia. Use caution in patients with pacemakers.
  • Pulsed dye laser has been used with some success.25
  • Intense pulsed light (IPL) has also been used in conjunction with the application of 5-aminolevulinic acid with success in a 6-case patient series.

Medication

Topical medications usually are the first category used in treating active disease. Use acid and intralesional therapies when topical therapy fails.

Immune response modifiers, topical

These agents are one of the first-line topical treatments for molluscum contagiosum, although not FDA approved for the indication.


Imiquimod (Aldara)

Induces secretion of IFN-alfa and other cytokines. Mechanisms of action are unknown. May be more effective in women than in men.

Adult

Apply 3 times qwk before hs; leave on skin for 6-10 h

Pediatric

Not established

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Not recommended for treatment of rectal, cervical, intravaginal, urethral, and intra-anal human papilloma infection; following surgery or drug treatment, do not use until genital/perianal tissue is healed

Chemovesicants

These are first-line topical agents, although they are not FDA approved for molluscum contagiosum. Effectiveness against warts may result from exfoliation.


Cantharidin (Verr-Canth)

Lytic action does not affect basal layer and has minimal effect on the corium. Scarring does not occur.

Adult

Remove keratin covering wart (avoid cutting viable tissue), apply topically (wart and 1-3 mm around), allow to dry, secure with nonporous tape
Protective cutout cushion over tape is helpful; patient may bathe and replace dressing in 24 h
Debride in 1-2 wk; if viable wart tissue remains, re-treat; > 3 treatments for large lesions
Treat one portion at a time in large mosaic warts, pare carefully because stinging may result from solvent on open tissue, treat 2 wk apart

Pediatric

Apply as in adults

Documented hypersensitivity; diabetes; impaired peripheral circulation; surrounding tissue that 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; not for use in the anogenital area; do not apply to eyes or mucosal tissue; avoid use in intertriginous sites because of problems with spreading and body occlusion, which often lead to more intense, painful reactions; do not use on birthmarks or unusual warts with hair; do not use on lesions with other agents

Keratolytics

The agents are used to aid in the removal of keratin in hyperkeratotic skin disorders, including corns, ichthyoses, common warts, flat warts, and other benign verrucae.


Tretinoin (Avita, Retin-A)

Inhibits microcomedo formation and eliminates lesions. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. Available as 0.025%, 0.05%, and 0.1% creams. Available also as 0.01% and 0.025% gels.
Begin with lowest tretinoin formulation and increase as tolerated.

Adult

Apply hs or qod; decrease frequency of application if irritation develops

Pediatric

<12 years: Not established
>12 years: Apply 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

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, or angles of nose


Trichloroacetic acid (Tri-Chlor)

Cauterizes skin, keratin, and other tissues. Although caustic, causes less local irritation and systemic toxicity than other medications in the same class. Response often is incomplete, and recurrence is frequent.
Must be applied by physician in office setting.

Adult

Paint on lesions, avoiding uninvolved skin; can be used in anal areas; repeat q 1-2 wk

Pediatric

Not established

Documented hypersensitivity; not for use on premalignant or malignant lesions

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 (AgNO3)

Second-line therapy after failure with first-line agents. Coagulates cellular protein and removes granulation tissue.
Must be applied by physician in office setting.

Adult

Apply to lesion for approximately 5 d

Pediatric

Apply as in adults

Decreases effects of sulfacetamide preparations

Documented hypersensitivity; broken skin; 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

Immune response modifiers, systemic

These are second-line agents for use in immunocompromised children.


Interferon alfa 2a and 2b (Roferon-A [alfa-2a], Intron A [alfa-2b])

Protein product manufactured by recombinant DNA technology. Mechanism of antitumor activity is not understood clearly; however, direct antiproliferative effects against malignant cells and modulation of host immune response may play important roles.

Adult

1 million U (10 million U/mL) SC per lesion 3 times qwk qod for 3 wk; inject intralesionally, preferably using a 25- to 30-gauge needle; as many as 5 lesions can be treated at once

Pediatric

Administer as in adults

Theophylline may increase toxicity; cimetidine may increase antitumor effects; zidovudine and vinblastine may increase toxicity

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 in severe hepatic or renal insufficiencies, seizure disorders, multiple sclerosis, or compromised CNS

Herbal formulations

These agents are over-the-counter, herbal alternatives.

Warning: Herbal formulations are not regulated by the FDA.


Australian lemon myrtle (Backhousia citriodora)

10% solution of essential oil of Australian lemon myrtle.

Adult

Apply topically to lesions qd

Pediatric

Apply as in adults

None documented, but presumed allergy to Australian lemon myrtle is a contraindication

Pregnancy
Precautions

Safety in pregnancy not tested

More on Molluscum Contagiosum

Overview: Molluscum Contagiosum
Differential Diagnoses & Workup: Molluscum Contagiosum
Treatment & Medication: Molluscum Contagiosum
Follow-up: Molluscum Contagiosum
Multimedia: Molluscum Contagiosum
References
[ CLOSE WINDOW ]

References

  1. Ackerman AB, Tanski EV. Pseudoleukemia cutis: report of a case in association with molluscum contagiosum. Cancer. Aug 1977;40(2):813-7. [Medline].

  2. Ahn BK, Kim BD, Lee SJ, Lee SH. Molluscum contagiosum infection during the treatment of vitiligo with tacrolimus ointment. J Am Acad Dermatol. Mar 2005;52(3 Pt 1):532-3. [Medline].

  3. Birthistle K, Carrington D. Molluscum contagiosum virus. J Infect. Jan 1997;34(1):21-8. [Medline].

  4. Blattner RJ. Molluscum contagiosum: eruptive infection in atopic dermatitis. J Pediatr. Jun 1967;70(6):997-9. [Medline].

  5. Brown ST, Nalley JF, Kraus SJ. Molluscum contagiosum. Sex Transm Dis. Jul-Sep 1981;8(3):227-34. [Medline].

  6. Buckley MM, Benfield P. Eutectic lidocaine/prilocaine cream. A review of the topical anaesthetic/analgesic efficacy of a eutectic mixture of local anaesthetics (EMLA). Drugs. Jul 1993;46(1):126-51. [Medline].

  7. Buckley R, Smith K. Topical imiquimod therapy for chronic giant molluscum contagiosum in a patient with advanced human immunodeficiency virus 1 disease. Arch Dermatol. Oct 1999;135(10):1167-9. [Medline].

  8. Bugert JJ, Darai G. Recent advances in molluscum contagiosum virus research. Arch Virol Suppl. 1997;13:35-47. [Medline].

  9. Buntin DM, Roser T, Lesher JL Jr, Plotnick H, Brademas ME, Berger TG. Sexually transmitted diseases: viruses and ectoparasites. Committee on Sexually Transmitted Diseases of the American Academy of Dermatology. J Am Acad Dermatol. Sep 1991;25(3):527-34. [Medline].

  10. Burke BE, Baillie JE, Olson RD. Essential oil of Australian lemon myrtle (Backhousia citriodora) in the treatment of molluscum contagiosum in children. Biomed Pharmacother. May 2004;58(4):245-7. [Medline].

  11. Charles NC, Friedberg DN. Epibulbar molluscum contagiosum in acquired immune deficiency syndrome. Case report and review of the literature. Ophthalmology. Jul 1992;99(7):1123-6. [Medline].

  12. Dohil MA, Lin P, Lee J, Lucky AW, Paller AS, Eichenfield LF. The epidemiology of molluscum contagiosum in children. J Am Acad Dermatol. Jan 2006;54:47-54. [Medline].

  13. Dourmashkin R, Bernhard W. A study with the electron microscope of the skin tumor of molluscum contagiosum. J Ultrastructure Research. 1959;3:11-38.

  14. Fery-Blanco C, Pelletier F, Humbert P, Aubin F. Disseminated molluscum contagiosum during topical treatment of atopic dermatitis with tacrolimus: efficacy of cidofovir. Ann Dermatol Venereol. May 2007;134:457-9. [Medline].

  15. Freeman CL, Moriarty AT. Molluscum contagiosum presenting as cellulitis in an AIDS patient: cytologic and ultrastructural features. Diagn Cytopathol. Jun 1995;12(4):345-9. [Medline].

  16. Gold MH, Boring MM, Bridges TM, Bradshaw VL. The successful use of ALA-PDT in the treatment of recalcitrant molluscum contagiosum. J Drugs Dermatol. Mar-Apr 2004;3(2):187-90. [Medline].

  17. Gottlieb SL, Myskowski PL. Molluscum contagiosum. Int J Dermatol. Jul 1994;33(7):453-61. [Medline].

  18. Hanna D, Hatami A, Powell J, Marcoux D, Maari C, Savard P, et al. A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children. Pediatr Dermatol. Nov-Dec 2006;23:574-9. [Medline].

  19. Horn CK, Scott GR, Benton EC. Resolution of severe molluscum contagiosum on effective antiretroviral therapy. Br J Dermatol. Apr 1998;138(4):715-7. [Medline].

  20. Lewis EJ, Lam M, Crutchfield CE. An update on molluscum contagiosum. Cutis. Jul 1997;60(1):29-34. [Medline].

  21. Mansur AT, Goktay F, Gunduz S, Serdar ZA. Multiple giant molluscum contagiosum in a renal transplant recipient. Transpl Infect Dis. Sep 2004;6(3):120-3. [Medline].

  22. Margolis S. Genital warts and molluscum contagiosum. Urol Clin North Am. Feb 1984;11(1):163-70. [Medline].

  23. Martin DH, Mroczkowski TF. Dermatologic manifestations of sexually transmitted diseases other than HIV. Infect Dis Clin North Am. Sep 1994;8(3):533-82. [Medline].

  24. Medical Economics Company. Intron A for Injection (Schering). PDR: Physicians' Desk Reference. 2001;[Full Text].

  25. Michel JL. Treatment of molluscum contagiosum with 585 nm collagen remodeling pulsed dye laser. Eur J Dermatol. Mar-Apr 2004;14(2):103-6. [Medline].

  26. Naert F, Lachapelle JM. Multiple lesions of molluscum contagiosum with metaplastic ossification. Am J Dermatopathol. Jun 1989;11(3):238-41. [Medline].

  27. Nageswaran A, Kinghorn GR. Sexually transmitted diseases in children: herpes simplex virus infection, cytomegalovirus infection, hepatitis B virus infection and molluscum contagiosum. Genitourin Med. Aug 1993;69(4):303-11. [Medline].

  28. Ordoukhanian E, Lane AT. Warts and molluscum contagiosum: beware of treatments worse than the disease. Postgrad Med. Feb 1997;101(2):223-6, 229-32, 235. [Medline].

  29. Pereira B, Fernandes C, Nachiambo E, Catarino MC, Rodrigues A, Cardoso J. Exuberant molluscum contagiosum as a manifestation of the immune reconstitution inflammatory syndrome. Dermatol Online J. 2007;13(2):6. [Medline].

  30. Postlethwaite R. Molluscum contagiosum. Arch Environ Health. Sep 1970;21(3):432-52. [Medline].

  31. Praetorius-Clausen F. Rare oral viral disorders (molluscum contagiosum, localized keratoacanthoma, verrucae, condyloma acuminatum, and focal epithelial hyperplasia). Oral Surg Oral Med Oral Pathol. Oct 1972;34(4):604-18. [Medline].

  32. Reed RJ, Parkinson RP. The histogenesis of molluscum contagiosum. Am J Surg Pathol. Jun 1977;1(2):161-6. [Medline].

  33. Ross GL, Orchard DC. Combination topical treatment of molluscum contagiosum with cantharidin and imiquimod 5% in children: a case series of 16 patients. Australas J Dermatol. May 2004;45(2):100-2. [Medline].

  34. Smith KJ, Yeager J, Skelton H. Molluscum contagiosum: its clinical, histopathologic, and immunohistochemical spectrum. Int J Dermatol. Sep 1999;38(9):664-72. [Medline].

  35. Sulica RL, Kelly J, Berberian BJ, Glaun R. Cutaneous cryptococcosis with molluscum contagiosum coinfection in a patient with acquired immunodeficiency syndrome. Cutis. Feb 1994;53(2):88-90. [Medline].

  36. Sutton JS, Burnett JW. Ultrastructural changes in dermal and epidermal cells of skin infected with Molluscum contagiosum virus. J Ultrastruct Res. Feb 1969;26(3):177-96. [Medline].

  37. Syed TA, Lundin S, Ahmad M. Topical 0.3% and 0.5% podophyllotoxin cream for self-treatment of molluscum contagiosum in males. A placebo-controlled, double-blind study. Dermatology. 1994;189(1):65-8. [Medline].

  38. Theos AU, Cummins R, Silverberg NB, Paller AS. Effectiveness of imiquimod cream 5% for treating childhood molluscum contagiosum in a double-blind, randomized pilot trial. Cutis. Aug 2004;74(2):134-8, 141-2. [Medline].

  39. Watanabe T, Tamaki K. Cidofovir diphosphate inhibits molluscum contagiosum virus DNA polymerase activity. J Invest Dermatol. Nov 15 2007;[Medline].

  40. Whitaker SB, Wiegand SE, Budnick SD. Intraoral molluscum contagiosum. Oral Surg Oral Med Oral Pathol. Sep 1991;72(3):334-6. [Medline].

  41. White CJ, Robey WH. Molluscum Contagiosum. J Med Res. 1902;7:255-77.

  42. Wilson LM, Reid CM. Molluscum contagiosum in atopic dermatitis treated with 0.1% tacrolimus ointment. Australas J Dermatol. Aug 2004;45(3):184-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

molluscum contagiosum, MC, molluscum contagiosum virus disease, MCV disease, opportunistic infection, sexually transmitted disease, STD, Henderson-Paterson body, Orthopoxvirus genus, renal transplantation, tacrolimus, topical immune suppressants, molluscum body

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ashish C Bhatia, MD, FAAD, Assistant Professor of Clinical Dermatology, Department of Dermatology, Northwestern University, Feinberg School of Medicine; Director of Clinical Research, Department of Dermatology and Dermatologic Surgery, River North Dermatology and Dermatologic Surgery, DuPage Medical Group
Ashish C Bhatia, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and Connective Tissue Oncology Society
Disclosure: Nothing to disclose.

Coauthor(s)

Tracy Campbell, MD, Staff Physician, Department of Dermatology, Rush Medical Center
Tracy Campbell, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Chicago Dermatological Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Seth Forman, MD, Department of Dermatology, Medical College of Virginia
Seth Forman, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

David Rowe, MD, Pathologist, Laboratory Medicine, Martha Jefferson Hospital
David Rowe, MD is a member of the following medical societies: United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Robert Orenstein, DO, Associate Professor, Department of Medicine, Medical College of Virginia, Virginia Commonwealth University; Medical Director, Infectious Disease Clinic, Medical College of Virginia Hospitals
Robert Orenstein, DO is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Julia R Nunley, MD, Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center
Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society
Disclosure: Johnson and Johnson stock holder dividends; Amgen stock holder dividends; Forest Lab, Inc stock holder dividends; Galaxo Smith Klein stock holder dividends; Covidien stock holder dividends; Novartis Grant/research funds Consulting; Biolex  sub-investigator

Medical Editor

Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences
Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.