eMedicine Specialties > Emergency Medicine > Dermatology
Molluscum Contagiosum: Treatment & Medication
Updated: Jul 2, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Emergency Department Care
In general, this disorder requires little, if any, emergency care.
- Benign neglect has been the most common therapy, as individual lesions will usually spontaneously resolve in 2-4 weeks.
- If secondary infection is suspected, then appropriate antistaphylococcal antibiotic coverage should be prescribed.
- Tetanus status should be updated if more than 5-10 years have elapsed since the last booster was given.
Consultations
- The patient should be referred to their primary care provider or a dermatologist for treatment. Therapies may include topical vesicants (eg, cantharidin), cryotherapy, curettage, or phototherapy with pulsed dye laser. Cimetidine has been beneficial in atopic patients with MCV infection. Immune-enhancing agents, such as Imiquimod, may stimulate clearance of the virus.
- In the case of widespread lesions or lesions that do not spontaneously resolve, HIV infection or other immunocompromised states must be considered. In such patients, more urgent consultation with a dermatologist or infectious disease specialist may be warranted. Treatment with systemic or topical antivirals, as well as antiretrovirals, may be beneficial.
Medication
There have been few well-controlled studies of compounds that may be beneficial in the treatment of molluscum contagiosum.
Since the disease process is self-limiting, invasive or toxic treatments are generally not indicated. More aggressive treatments, such as antivirals, may be required for immunocompromised patients.
For the most part, lesions are treated by destructive, immune-enhancing, or antiviral means. The goal of treatment is to minimize the number of lesions without causing unnecessary scarring.
The mainstay therapy for immunocompetent patients is destruction of the lesions with a variety chemical and physical agents. The treatments of choice at this time are probably cantharidin (a vesicant) and cryotherapy.
Curettage is another treatment option but is more painful and more likely to leave scars. The advantage is that tissue is obtained for diagnostic confirmation.
Other topical treatments reported include salicylic acid and tretinoin gel 0.01%. Silver nitrate, phenol, and trichloroacetic acid have been used, although, again, these are associated with more pain and scarring.
Antihistamines (H2 blockers)
A study of 13 children with molluscum contagiosum, in whom conventional methods of treatment were unsuccessful or difficult to apply, showed improvement with a 2-month course of cimetidine.1 Of the 13 participants, 12 completed the course of medication, and 9 of the 12 experienced a clearance of all lesions. The remaining 3 showed no new lesions, but some of their lesions were persistent.
This has been reported effective in atopic individuals as well.
Cimetidine (Tagamet)
H2 antagonist useful in treating pruritus, urticaria, and contact dermatitis. Mechanisms of action in the treatment of molluscum contagiosum are poorly understood.
Adult
300 mg PO qid; however, dosage can vary
Pediatric
30-40 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
Antiviral drugs
Presumably, antiviral drugs may interfere with ability of molluscum contagiosum virus to replicate.
Cidofovir (Vistide)
Selective inhibitor of viral DNA production in CMV and other herpes viruses. One case report showed improvement in 3 of 3 patients with HIV and extensive co-infection with molluscum contagiosum.2 Improvement was noted with topical or IV formulations.
Adult
5 mg/kg IV over 1 h, once q2wk
May be applied topically to lesions, as 3% solution, 5 times/wk for 8 wk
Pediatric
Administer as in adults
Coadministration of aminoglycosides, amphotericin B, IV pentamidine, and foscarnet may increase nephrotoxicity
Documented hypersensitivity; coadministration with other nephrotoxic agents; serum creatinine >1.5 mg/dL; a CrCl <55 mL/min; urine protein >100 mg/dL
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
Monitor neutrophil counts; renal toxicity is major adverse effect; prehydrate with normal saline IV and coadminister probenecid with each infusion to minimize nephrotoxicity (monitor renal function); monitor serum creatinine and urine protein 48 h prior to treatment (adjust dose accordingly); granulocytopenia may occur; topical use may lead to varioliform scarring
Keratolytic agents
Cause cornified epithelium to swell, soften, macerate, and then desquamate.
Cantharidin (Verr-Canth)
Causes inflammatory reaction to lesion, causing expulsion of lesion contents. Unlikely to scar. Painful if applied to surrounding, intact skin. 90% successful in clearing of lesion.
Adult
0.7% solution, in flexible collodion; apply every month directly to visible lesions, avoiding surrounding skin; wash off in 2-6 h, or at first sign of blistering
Pediatric
Administer as in adults; pretreatment with acetaminophen or ibuprofen may minimize discomfort experienced with blistering
None reported
Documented hypersensitivity; diabetes; impaired peripheral circulation; use on eyes, mucous membranes, anogenital or intertriginous areas, moles, or birthmarks; lesions caused with other agents or if surrounding tissue is swollen or irritated; avoid facial application
Pregnancy
A - Fetal risk not revealed in controlled studies in humans
Precautions
Strong vesicant to be used sparingly; not for use in the anogenital area; not for application to eyes and mucosal tissue; avoid use in intertriginous sites due to problems with spreading and body occlusion, which often lead to more intense, painful reactions; avoid facial use
Cytotoxic agents
These agents are used to inhibit deregulated cell growth and eliminate viral infected cells.
Podophyllum resin (Pod-Ben-25, Podocon-25)
Isolated from resins that are found in plants (eg, May apple, mandrake). A multicenter, double-blinded, placebo-controlled study involving 150 patients demonstrated cure rates of 16%, 52%, and 92% in control, 0.3% and 0.5% creams, respectively.3 Treatment was bid for 3 d and extended to 4 wk if not resolved within the initial 3 d.
Adult
Apply for 30-40 min to determine patient's sensitivity, and subsequent doses are applied sparingly according to clinical effect (ie, 1-4 h); following elapsed time, material should be removed with an alcohol swab or soap and water
Pediatric
Apply as in adults
None reported
Documented hypersensitivity; diabetes; impaired peripheral circulation; avoid use on mucous membranes, eyes, bleeding warts, moles, birthmarks, or unusual warts with hair
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Do not use on lesions that appear to be secondarily infected; do not use large amounts of the drug and avoid contact with the cornea; the 25% solution should not be applied near the mucous membranes
Salicylic acid and liquid nitrogen
These medications are used to destroy or remove lesions. They are applied topically and often are applied multiple times with intervening debridement of the lesions.
Adult
Apply sparingly to affected area
Pediatric
Apply as in adults
None reported
Documented hypersensitivity; diabetes; impaired peripheral circulation; do not use on eyes, mucous membranes, ano-genital 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
A - Fetal risk not revealed in controlled studies in humans
Precautions
Avoid contact with eyes and mucous membranes; if contact with eyes or mucous membranes occurs, immediately flush with water for 15 min; avoid inhaling the vapors
Retinoids
Vitamin A derivatives have many roles. They encourage cellular differentiation, are antiproliferative, and serve as immunomodulators.
Tretinoin (Retin-A, Renova)
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
Tretinoin 0.1% cream is applied to lesions qod; advance to bid as tolerated for 4-6 wk; cease application if erythema develops
Tretinoin 0.05% cream also used with success
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Other skin irritants (ie, astringents, benzoyl peroxide, salicylic acid, resorcinol, topical sulfur, other keratolytics, abrasives, astringents, spices, lime) may exacerbate irritation; coadministration with other drugs causing photosensitivity (eg, tetracycline, sulfonamides) may increase risk of sunburn
Documented hypersensitivity; pregnancy
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with excessive sunlight exposure; burning, stinging, peeling, pruritus, or erythema has been reported at site of application; caution with eczema (may cause severe irritation); avoid contact with mucous membranes, mouth, and angles of nose
Skin and mucous membrane agents
These agents may have immunomodulatory effects.
Imiquimod (Aldara)
Imiquimod 5% cream has been used topically to treat MCV. Induces secretion of interferon alpha and other cytokines; mechanism of action are unknown. It is a potent immunomodulatory agent. May be more effective in women than in men.
Adult
5% cream: Apply 3 times qwk hs; leave on skin for 6-10 h
Pediatric
Not established
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
Genital use: Not recommended for treatment of rectal, cervical, intravaginal, urethral, and intra-anal human papilloma infection; following surgery or drug treatment, do not use topical imiquimod until genital/perianal tissue is healed
Actinic keratosis: Avoid exposure to sunlight or artificial tanning; regular use of sunscreen is encouraged; avoid contact with lips, eyes, or nostrils; common adverse effects include erythema, edema, vesicles, erosion or ulceration, weeping, exudate, flaking, scaling, dryness, and scabbing or crusting
Basal cell carcinoma: Medical follow-up is essential to assure cancer has responded adequately to treatment; may cause redness, swelling, and sore development at application site; may cause itching or burning
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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Meadows KP, Tyring SK, Pavia AT. Resolution of recalcitrant molluscum contagiosum virus lesions in human immunodeficiency virus-infected patients treated with cidofovir. Arch Dermatol. 1997;133(8):987-90. [Medline].
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].
Binder B, Weger W, Komericki P, Kopera D. Treatment of molluscum contagiosum with a pulsed dye laser: Pilot study with 19 children. J Dtsch Dermatol Ges. Feb 2008;6(2):121-5. [Medline].
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Peter G, ed. American Academy of Pediatrics, Molluscum Contagiosum. In: Red Book: Report on the Committee on Infectious Diseases. 24th ed. 1997:364.
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