Molluscum Contagiosum Medication

Updated: Aug 10, 2017
  • Author: Ashish C Bhatia, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

Molluscum contagiosum usually resolves within months in people with a normal immune system. Many treatments have been promoted for molluscum contagiosum. The common goal of most treatment methods is the destruction of lesions and the development of a localized inflammatory reaction. Extensive controlled studies have not been performed and all treatments have advantages and disadvantages. A review for the Cochrane Database examined the effects of several topical, systemic, and homeopathic interventions. [29]  One report suggested using a 10% solution of essential oil of Australian lemon myrtle (Backhousia citriodora). [61]

Among the findings, the investigators determined that there was limited evidence for the efficacy of sodium nitrite coapplied with salicylic acid compared with salicylic acid alone.

In addition, no statistically significant differences were found for topical povidone iodine plus salicylic acid compared with either povidone iodine or salicylic acid alone

The investigators also found no statistically significant differences between treatment with placebo and therapy with potassium hydroxide or between placebo treatment and systemic treatment with cimetidine or calcarea carbonica, a homeopathic drug.

The authors concluded no single intervention has been shown to be convincingly effective in treating molluscum contagiosum. However, various limitations were found in the studies reviewed, and the investigators cautioned that small study sizes may have caused some important treatment differences to be missed. None of the evaluated treatment options were associated with serious adverse effects.

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Keratolytic Agents

Class Summary

These agents inhibit cell growth and destroy infected cells. They are applied directly to lesions. To decrease discomfort, treat a small number of lesions at each visit.

Salicylic acid (Compound W, Freezone, Wart-Off)

Salicylic acid produces desquamation and inflammation. Various liquid products that contain 17% salicylic acid as the caustic agent or as part of a mix of caustic agents used to treat molluscum contagiosum and warts are available. Most of these products include an adhesive such as collodion or a clear nail-polishlike material, which dries within seconds of application. This helps to concentrate the caustic agent on the lesion and minimize spread to the surrounding skin.

Tretinoin topical (Retin-A, Avita, Tretin-X)

Tretinoin is available in various bases and concentrations (0.025%, 0.05%, 0.1% cream; 0.01%, 0.025%, 0.1% gel; 0.05% solution). Applied to a region of skin with scattered lesions, tretinoin may produce eczema and increase the number of lesions through autoinoculation. However, a small amount of tretinoin may be applied to individual lesions with good effect.

Cantharidin

Cantharidin is a strong vesicant. It has not been approved by the FDA for the treatment of any condition but has been safely and effectively used by dermatologists for years. In the American Academy of Dermatology treatment guidelines for warts, it is listed as the second-line therapy following liquid nitrogen. However, because cantharidin has never been approved by the FDA for use in humans, it is no longer marketed in the United States.

Cantharidin crystals and diluent can be purchased in the United States, and numerous dermatologists continue to use it. Cantharidin solution for the treatment of warts and molluscum is available in Canada and many other countries. The effectiveness results from the exfoliation of the lesion as a consequence of cantharidin's vesicant action. The lytic action does not go below the basement membrane of epidermal cells. As a result, unless the area becomes secondarily traumatized or infected, no scarring from topical application occurs.

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Topical Skin Products

Class Summary

These agents induce cytokines, including interferon. They are typically reserved for use in patients with molluscum contagiosum that is refractory to cryotherapy or tretinoin.

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Antivirals, Other

Class Summary

Presumably, antiviral drugs may interfere with the ability of the molluscum contagiosum virus to replicate. Because of their expense and adverse effect potential, consider these products for use only in immunocompromised patients.

Cidofovir (Vistide)

Cidofovir is a selective inhibitor of viral DNA production in cytomegalovirus and other herpes viruses. One case report showed improvement in 3 out of 3 patients with HIV and extensive co-infection with molluscum contagiosum virus.

Ritonavir (Norvir)

Ritonavir is an antiretroviral protease inhibitor. In one case report, a patient with HIV and intractable molluscum contagiosum had resolution of lesions after treatment.

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