eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Molluscum Contagiosum: Treatment & Medication

Author: Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Contributor Information and Disclosures

Updated: Aug 5, 2009

Treatment

Medical Care

  • Before attempting any therapy, educate the patient or parents in-depth about the diagnosis, prognosis, risk of autoinoculation or infection of others, therapeutic options, and risks of therapy.12,13 More than one treatment session is frequently required. Providing this information at the first clinical visit is particularly important when treating benign lesions, such as molluscum contagiosum (MC) and common warts. A few extra minutes of explanation at this stage can prevent or mitigate numerous problems and questions during later visits. When lesions fail to respond to initial therapy, a temptation to be overzealous in treatment may occur. Patients and families are more understanding and less likely to demand aggressive therapy when reasonable goals and limitations of therapy are thoroughly discussed.
  • In healthy patients, molluscum contagiosum is generally self-limited and heals spontaneously after several months. Individual lesions are seldom present for more than 2 months. Although treatment is not required, it may help reduce autoinoculation or transmission to close contacts and improve clinical appearance.
  • The most appropriate therapeutic approach largely depends on the clinical situation. In healthy children, a major goal is to limit discomfort, and benign neglect or minor direct lesional trauma is appropriate. In adults who are more motivated to have their lesions treated, cryotherapy or curettage of individual lesions is effective and well tolerated. In immunocompromised individuals, molluscum contagiosum may be very extensive and difficult to treat. The goal may be to treat the most troublesome lesions only. In severe cases, these patients may warrant more aggressive therapy with lasers, imiquimod, antiviral therapy, or combinations of these. Of course, effective antiretroviral therapy in patients with AIDS makes therapy of molluscum contagiosum much more effective.
  • Controlled studies that compare treatments have not been performed, and all treatments have benefits and disadvantages. A review for the Cochrane Database in April 2006 examined the effects of several topical, systemic, and homeopathic interventions.14
    • Limited evidence demonstrated the efficacy of sodium nitrite coapplied with salicylic acid compared with salicylic acid alone.
    • No statistically significant differences were found for topical povidone iodine plus salicylic acid compared with povidone iodine alone or compared with salicylic acid alone.
    • Also, no statistically significant differences were found when potassium hydroxide was compared with placebo; systemic treatment with cimetidine versus placebo or systemic treatment with calcarea carbonica, a homeopathic drug, versus placebo.
    • Study limitations were numerous and may have led to important differences being missed.
    • None of the evaluated treatment options were associated with serious adverse effects.
    • The authors concluded no single intervention has been shown to be convincingly effective in treating molluscum contagiosum.
  • Hanna et al reported a prospective randomized trial that compared the efficacy and adverse effects of 4 recognized treatments of molluscum contagiosum in children.15 They compared 4 treatments in 124 children. One group was treated with curettage, a second with cantharidin, a third with a combination of salicylic acid and lactic acid, and a fourth with imiquimod. Curettage was found to be the most efficacious treatment and had the lowest rate of side effects, but it must be performed with adequate anesthesia and is a time-consuming procedure. Cantharidin had moderate complications due to blisters and was slightly less effective. The topical keratolytic used was too irritating for children. Topical imiquimod was more effective than cantharidin but is expensive, and an optimum treatment schedule is yet to be reported.
  • Therapeutic options can be divided into several broad categories, including benign neglect, direct lesional trauma, immune response stimulation, and antiviral therapy.
    • Benign neglect
      • Leaving mollusca to spontaneously resolve is often reasonable,16 especially in young children for whom freezing or curettage may be painful and frightening. The dictum primum non nocere (first do no harm) has a special significance in children with minor self-limited conditions. Many physicians refuse to treat children with small numbers of mollusca.
      • Lesions on the eyelids and central face may be particularly distressing to parents and patients. When possible, treat lesions at other locations first, with the hope that the treatment may stimulate the facial lesions to spontaneously resolve. When facial lesions require treatment, the best option is to treat them frequently with minor physical trauma.
      • More aggressive therapy may be required in patients in whom the extent of disease is intolerable and in patients who are immunocompromised.
    • Direct lesional trauma
      • Takematsu et al reported that disruption of the epidermal wall of molluscum bodies induces acute inflammatory changes by activation of the alternative complement pathway on exposure to the tissue fluids; furthermore, the molluscum bodies release proinflammatory cytokines and other neutrophil chemotactic factors upon decomposition.17 This supports the observation that minor trauma to molluscum lesions frequently produces an inflammatory response and resolution of the lesion. The molluscum bodies can be ruptured and a local inflammatory response created by various forms of physical trauma and caustic topical agents.
      • For information on physical trauma treatments, see Surgical Care.
      • Various caustic agents have been shown to be effective in treating molluscum contagiosum. Tretinoin, salicylic acid, and potassium hydroxide (KOH)18,19 may be prescribed for application at home. Cantharidin,20 silver nitrate,21 trichloroacetic acid, and phenol should be applied in the office. Children may tolerate therapy with these agents better than curettage or cryotherapy. None of these caustic agents have been approved by the US Food and Drug Administration (FDA) for treatment of molluscum contagiosum.
      • Tretinoin cream 0.1% or gel 0.025% is applied daily. Apply to a region of skin with scattered lesions. It may produce eczema and may increase the number of lesions through autoinoculation; however, a small amount of tretinoin may be applied to individual lesions with the rough end of a broken toothpick. Rotate the toothpick, gently abrading the lesion and increasing the inflammatory response produced by the tretinoin. Treat lesions every few days until significant inflammation or resolution occurs.
      • KOH is a strong alkali that has long been known to digest proteins, lipids, and most other epithelial debris of skin scrapings to identify fungal infections. Topical 10% KOH aqueous solution applied twice daily on each MC lesion until all lesions undergo inflammation and superficial ulceration may be effective in clearing molluscum contagiosum in children.
      • Cantharidin is a chemovesicant that is highly effective in treating molluscum contagiosum but has lost favor with some physicians because of concerns regarding its safety. However, if cantharidin is used properly, it is very effective, safe, and well tolerated by children. In a study by Silverberg et al, 300 patients were treated with cantharidin.22 Ninety percent of patients experienced compete clearing with an average of 2.1 visits. Blisters occurred at sites of application in 92% of patients. Temporary burning, pain, erythema, or pruritus was reported in 6-37% of patients. No major adverse effects were reported, and no patients experienced secondary bacterial infection. A total of 95% of parents reported they would proceed with cantharidin therapy again.
      • Cantharidin is not approved by the FDA for treatment of any condition; however, it has been used safely and effectively by dermatologists for many years.23,24 It is listed as acceptable therapy in the American Academy of Dermatology treatment guidelines for warts; however, because it has never been approved by the FDA for use in humans, it is no longer marketed as medical therapy in the United States. Cantharidin crystals and diluent can be purchased in the United States, and many dermatologists continue to use it. Cantharidin solution for the treatment of warts and molluscum is available in Canada and many other countries.
      • Seventeen percent salicylic acid in collodion (Compound W, Freezone, Wart-Off, Occlusal) is commonly used in treating verruca vulgaris. In most patients, repeated application to individual molluscum contagiosum lesions until an inflammatory response is generated is effective therapy.
    • Immune response stimulation
      • Imiquimod cream,25,26,27,15,28,29 intralesional interferon alfa,30 and topical injections of streptococcal antigen31 have been shown to be effective in treating patients with resistant molluscum contagiosum. The high cost of these products limits their use to more extensive or resistant infections. Imiquimod cream applied 3 times a week for 16 weeks is an option in severe cases. The dosing schedule and length of treatment require further evaluation.
      • Imiquimod is a novel topical immune response modifier, which is a potent inducer of interferons. Various treatment regimens have been effective in treating molluscum contagiosum. In children32,33 and in some patients with AIDS-associated molluscum contagiosum,34,35 1% cream applied 3 times per day or 5% cream applied at every bedtime for 4 weeks appears to be effective treatment.
    • Antiviral therapy
      • In immunocompromised patients, improvement of lesions has been observed in individual patients treated with ritonavir, cidofovir (intravenous and topical),36,37 and zidovudine.
      • Not surprisingly, patients with AIDS and severe molluscum contagiosum improve with effective antiretroviral therapy.

Surgical Care

  • 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,38,39 expression of the central core with tweezers, rupture of the central core with a needle or a toothpick,40,41 electrodesiccation, shave removal, or duct tape occlusion.42
  • 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) therapy43,44,45,46 has been shown to be more than 95% successful in treating individual lesions after one 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, it may be considered for treatment of extensive or resistant lesions. It may also be valuable in immunocompromised individuals with extensive disease.
  • 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, as follows:
    • Lesions may be sprayed with ethyl chloride until frosting has occurred and scraped away with a curette.
    • The application of local anesthetic cream, EMLA (a eutectic mixture of 5% lignocaine and prilocaine) or equivalent, may permit painless treatment. The cream is best applied under occlusion 1-2 hours before the planned procedure.

Activity

  • Instruct the patient to avoid activities or sports involving physical contact between infected areas of skin and exposed skin of other participants.

Medication

Molluscum contagiosum (MC) 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.

The ideal treatment for molluscum contagiosum depends on many factors including patient/parent preference, fear, cost, travel time to the office, number and distribution of lesions, associated medical conditions, and immune status. Before attempting any therapy, educate the patient and parents in depth about the diagnosis, prognosis, risk of autoinoculation and infection of others, therapeutic options, and risks of therapy. Providing this background and prognosis at the first clinic visit is important in minimizing disappointment associated with "treatment failure."

Cytotoxic and caustic agents

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, Occlusal)

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 MCV 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 surrounding skin.

Adult

Apply to individual lesions qd/bid; continue until lesions become inflamed or begin resolving; improvement should occur within 2-3 wk

Pediatric

Apply as in adults

Documented hypersensitivity; prolonged use in infants, individuals with diabetes, and patients with impaired circulation

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

Avoid contact with mucous membranes; these products should rarely, if ever, be used near the eyes or on the face of young children who are at risk of rubbing the material into the eyes, following application; immediately flush with water for 15 min if contact with eyes or mucous membranes occurs; avoid inhaling vapors


Tretinoin (Retin-A, Avita)

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.

Adult

Apply with a clean broken toothpick or similar item that is dipped into tretinoin (0.025% gel); scratch or rotate into individual lesions, gently abrading them and increasing the inflammatory response produced by the tretinoin; lesions are treated every few days until significant inflammation or resolution occurs

Pediatric

Apply as in adults

Irritant reactions increase with coadministration of benzoyl peroxide, salicylic acid, and resorcinol; avoid topical sulfur, resorcinol, salicylic acid, other keratolytics, abrasives, astringents, spices, and lime

Documented hypersensitivity; prolonged use not recommended, especially in infants, individuals with diabetes, and patients with impaired circulation

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

Topical retinoids may increase sensitivity to sun exposure; patients may perform normal outdoor activities with reasonable precautions to minimize ultraviolet exposure


Cantharidin (Verr-Canth, Cantharone)

This is a strong vesicant. It is not approved by the FDA for 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 it 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 its 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.

Adult

Apply a small amount to individual lesions and allow to dry; cover the site with nonporous tape to minimize accidental contact with areas of noninvolved skin; remove the dressing and wash the site gently after 2-3 h
A small blister usually forms at the site, treat with routine wound care; a single application is usually adequate to treat an individual lesion

Pediatric

Apply as in adults; this product is very effective and produces minimal discomfort, any discomfort occurs well after the child leaves the office and, therefore, is not associated with the visit to the doctor

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

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

Only apply in an office setting; because of the risk of inappropriate use, never provide for home application
Apply sparingly; do not apply to eyes or mucosal tissue; should rarely, if ever, be used near the eyes in any patient or on the face of young children who are at risk of rubbing the material into the eyes; immediately flush with water for 15 min, if contact with eyes or mucous membranes occur
Avoid use in intertriginous sites because of problems with spreading and body occlusion, which often lead to more intense painful reactions; discomfort is minimal and usually consists of pruritus, which begins 1-2 h after application

Immune response modifiers, topical

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


Imiquimod 5% cream (Aldara)

Induces secretion of IFN-alfa and other cytokines; mechanisms of action are unknown.

Adult

Apply topically 3 times/wk 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

Antiviral drugs

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


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 MC.

Adult

5 mg/kg IV over 1 h, once q2wk

Pediatric

Limited data exist; 5 mg/kg IV over 1 h, once q2wk
Also has been applied as a topical extemporaneously compounded 3% gel once daily, 5 times/wk

Zidovudine, foscarnet, acetaminophen, aminosalicylic acid, barbiturates, methotrexate, famotidine, nonsteroidal anti-inflammatory drugs, furosemide, theophylline, ACE inhibitors, and clofibrate may increase cidofovir toxicity

Documented hypersensitivity; coadministration with other nephrotoxic agents; serum creatinine level >1.5 mg/dL, creatinine clearance <55 mL/min, or urine protein level >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

May cause granulocytopenia (monitor neutrophil counts); IV prehydration with 0.9% NaCl and concurrent administration with probenecid in each infusion can minimize nephrotoxicity; monitor serum creatinine and urine protein within 48 h before each dose (adjust dose accordingly)


Ritonavir (Norvir)

Antiretroviral protease inhibitor. In one case report, a patient with HIV and intractable MC had resolution of lesions after being treated.

Adult

300-600 mg PO bid pc

Pediatric

Infants and children: Limited data are reported; initially 250 mg/m2 bid and titrate upward over 5 d to 400 mg/m2 bid

Potent inhibitor of CYP450 3A4; arrhythmias, hematologic abnormalities, and seizures, or other potentially serious adverse effects are associated with the coadministration of ritonavir with propoxyphene, quinidine, amiodarone, bupropion, cisapride, clozapine, encainide, astemizole, bepridil, flecainide, meperidine, rifabutin, piroxicam, propafenone, and terfenadine
Alprazolam, clorazepate, diazepam, estazolam, flurazepam, midazolam, triazolam, and zolpidem concentrations significantly increase when coadministered with ritonavir causing extreme sedation and respiratory depression

Documented hypersensitivity; concomitant administration with cisapride, benzodiazepines, narcotics, anesthetics, antiarrhythmics, or amiodarone

Pregnancy

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

Precautions

Caution with hepatic insufficiency and those being treated with antiarrhythmic agents
Administer with food; may cause nausea, emesis, diarrhea, circumoral paresthesia, taste alteration, increased cholesterol and triglycerides, hyperglycemia, pancreatitis, or increased LFT findings

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. Scholz J, Rosen-Wolff A, Bugert J, et al. Epidemiology of molluscum contagiosum using genetic analysis of the viral DNA. J Med Virol. Feb 1989;27(2):87-90. [Medline].

  2. Choong KY, Roberts LJ. Molluscum contagiosum, swimming and bathing: a clinical analysis. Australas J Dermatol. May 1999;40(2):89-92. [Medline].

  3. Mahe A, Prual A, Konate M, Bobin P. Skin diseases of children in Mali: a public health problem. Trans R Soc Trop Med Hyg. Sep-Oct 1995;89(5):467-70. [Medline].

  4. Konya J, Thompson CH. Molluscum contagiosum virus: antibody responses in persons with clinical lesions and seroepidemiology in a representative Australian population. J Infect Dis. Mar 1999;179(3):701-4. [Medline].

  5. Becker TM, Blount JH, Douglas J, Judson FN. Trends in molluscum contagiosum in the United States, 1966-1983. Sex Transm Dis. Apr-Jun 1986;13(2):88-92. [Medline].

  6. Laxmisha C, Thappa DM, Jaisankar TJ. Clinical profile of molluscum contagiosum in children versus adults. Dermatol Online J. Dec 2003;9(5):1. [Medline]. [Full Text].

  7. Betlloch I, Pinazo I, Mestre F, et al. Molluscum contagiosum in human immunodeficiency virus infection: response to zidovudine. Int J Dermatol. Jun 1989;28(5):351-2. [Medline].

  8. Senkevich TG, Koonin EV, Bugert JJ, et al. The genome of molluscum contagiosum virus: analysis and comparison with other poxviruses. Virology. Jun 23 1997;233(1):19-42. [Medline].

  9. Munoz-Perez MA, Colmenero MA, Rodriguez-Pichardo A, et al. Disseminated cryptococcosis presenting as molluscum-like lesions as the first manifestation of AIDS. Int J Dermatol. Sep 1996;35(9):646-8. [Medline].

  10. Buller RM, Burnett J, Chen W, Kreider J. Replication of molluscum contagiosum virus. Virology. Nov 10 1995;213(2):655-9. [Medline].

  11. Cribier B, Scrivener Y, Grosshans E. Molluscum contagiosum: histologic patterns and associated lesions. A study of 578 cases. Am J Dermatopathol. Apr 2001;23(2):99-103. [Medline].

  12. Smolinski KN, Yan AC. How and when to treat molluscum contagiosum and warts in children. Pediatr Ann. Mar 2005;34(3):211-21. [Medline].

  13. [Guideline] Clinical Effectiveness Group. National guideline for the management of molluscum contagiosum. Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). Sex Transm Infect. Aug 1999;75 Suppl 1:S80-1. [Medline].

  14. [Best Evidence] van der Wouden JC, Menke J, Gajadin S, Koning S, Tasche MJ, van Suijlekom-Smit LW. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2006;(2):CD004767. [Medline].

  15. Hanna D, Hatami A, Powell J, 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(6):574-9. [Medline].

  16. 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].

  17. Takematsu H, Tagami H. Proinflammatory properties of molluscum bodies. Arch Dermatol Res. 1994;287(1):102-6. [Medline].

  18. Romiti R, Ribeiro AP, Grinblat BM, et al. Treatment of molluscum contagiosum with potassium hydroxide: a clinical approach in 35 children. Pediatr Dermatol. May-Jun 1999;16(3):228-31. [Medline].

  19. Romiti R, Ribeiro AP, Romiti N. Evaluation of the effectiveness of 5% potassium hydroxide for the treatment of molluscum contagiosum. Pediatr Dermatol. Nov-Dec 2000;17(6):495. [Medline].

  20. 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].

  21. Niizeki K, Hashimoto K. Treatment of molluscum contagiosum with silver nitrate paste. Pediatr Dermatol. Sep-Oct 1999;16(5):395-7. [Medline].

  22. Silverberg NB, Sidbury R, Mancini AJ. Childhood molluscum contagiosum: experience with cantharidin therapy in 300 patients. J Am Acad Dermatol. Sep 2000;43(3):503-7. [Medline].

  23. Cathcart S, Coloe J, Morrell DS. Parental satisfaction, efficacy, and adverse events in 54 patients treated with cantharidin for molluscum contagiosum infection. Clin Pediatr (Phila). Mar 2009;48(2):161-5. [Medline].

  24. Epstein E. Cantharidin treatment of molluscum contagiosum. Acta Derm Venereol. 1989;69(1):91-2. [Medline].

  25. 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].

  26. Metkar A, Pande S, Khopkar U. An open, nonrandomized, comparative study of imiquimod 5% cream versus 10% potassium hydroxide solution in the treatment of molluscum contagiosum. Indian J Dermatol Venereol Leprol. Nov-Dec 2008;74(6):614-8. [Medline].

  27. Skinner RB Jr, Ray S, Talanin NY. Treatment of molluscum contagiosum with topical 5% imiquimod cream. Pediatr Dermatol. Sep-Oct 2000;17(5):420. [Medline].

  28. Barba AR, Kapoor S, Berman B. An open label safety study of topical imiquimod 5% cream in the treatment of molluscum contagiosum in children. Dermatol Online J. Feb 2001;7(1):20. [Medline].

  29. Hengge UR, Esser S, Schultewolter T. Self-administered topical 5% imiquimod for the treatment of common warts and molluscum contagiosum. Br J Dermatol. Nov 2000;143(5):1026-31. [Medline].

  30. Nelson MR, Chard S, Barton SE. Intralesional interferon for the treatment of recalcitrant molluscum contagiosum in HIV antibody positive individuals--a preliminary report. Int J STD AIDS. Sep-Oct 1995;6(5):351-2. [Medline].

  31. Inui S, Asada H, Yoshikawa K. Successful treatment of molluscum contagiosum in the immunosuppressed adult with topical injection of streptococcal preparation OK-432. J Dermatol. Sep 1996;23(9):628-30. [Medline].

  32. Myhre PE, Levy ML, Eichenfield LF, Kolb VB, Fielder SL, Meng TC. Pharmacokinetics and safety of imiquimod 5% cream in the treatment of molluscum contagiosum in children. Pediatr Dermatol. Jan-Feb 2008;25(1):88-95. [Medline].

  33. Bayerl C, Feller G, Goerdt S. Experience in treating molluscum contagiosum in children with imiquimod 5% cream. Br J Dermatol. Nov 2003;149 Suppl 66:25-9. [Medline].

  34. Brown CW Jr, O'Donoghue M, Moore J, Tharp M. Recalcitrant molluscum contagiosum in an HIV-afflicted male treated successfully with topical imiquimod. Cutis. Jun 2000;65(6):363-6. [Medline].

  35. 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].

  36. Toro JR, Wood LV, Patel NK. Topical cidofovir: a novel treatment for recalcitrant molluscum contagiosum in children infected with human immunodeficiency virus 1. Arch Dermatol. Aug 2000;136(8):983-5. [Medline].

  37. Zabawski EJ Jr, Cockerell CJ. Topical cidofovir for molluscum contagiosum in children. Pediatr Dermatol. Sep-Oct 1999;16(5):414-5. [Medline].

  38. Martin-Garcia RF, Garcia ME, Rosado A. Modified curettage technique for molluscum contagiosum. Pediatr Dermatol. Mar-Apr 2007;24(2):192-4. [Medline].

  39. Simonart T, De Maertelaer V. Curettage treatment for molluscum contagiosum: a follow-up survey study. Br J Dermatol. Nov 2008;159(5):1144-7. [Medline].

  40. Squeezing causes less scarring than phenol ablation in molluscum contagiosum. BMJ. Dec 11 1999;319(7224):E. [Medline].

  41. Weller R, O'Callaghan CJ, MacSween RM, White MI. Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation. BMJ. Dec 11 1999;319(7224):1540. [Medline].

  42. Lindau MS, Munar MY. Use of duct tape occlusion in the treatment of recurrent molluscum contagiosum. Pediatr Dermatol. Sep-Oct 2004;21(5):609. [Medline].

  43. 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].

  44. Chatproedprai S, Suwannakarn K, Wananukul S, Theamboonlers A, Poovorawan Y. Efficacy of pulsed dyed laser (585 nm) in the treatment of molluscum contagiosum subtype 1. Southeast Asian J Trop Med Public Health. Sep 2007;38(5):849-54. [Medline].

  45. Hammes S, Greve B, Raulin C. [Molluscum contagiosum: treatment with pulsed dye laser]. Hautarzt. Jan 2001;52(1):38-42. [Medline].

  46. Hughes PS. Treatment of molluscum contagiosum with the 585-nm pulsed dye laser. Dermatol Surg. Feb 1998;24(2):229-30. [Medline].

  47. Hornor G. Ano-genital warts in children: Sexual abuse or not?. J Pediatr Health Care. Jul-Aug 2004;18(4):165-70. [Medline].

  48. 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].

  49. Bauer JH, Miller OF, Peckham SJ. Medical Pearl: confirming the diagnosis of molluscum contagiosum using 10% potassium hydroxide. J Am Acad Dermatol. May 2007;56(5 Suppl):S104-5. [Medline].

  50. Braue A, Ross G, Varigos G, Kelly H. Epidemiology and impact of childhood molluscum contagiosum: a case series and critical review of the literature. Pediatr Dermatol. Jul-Aug 2005;22(4):287-94. [Medline].

  51. Bugert JJ, Lohmuller C, Darai G. Characterization of early gene transcripts of molluscum contagiosum virus. Virology. Apr 25 1999;257(1):119-29. [Medline].

  52. Bugert JJ, Melquiot NV, Darai G. Mapping of mRNA transcripts in the genome of molluscum contagiosum virus: transcriptional analysis of the viral slam gene family. Virus Genes. Oct 2000;21(3):189-92. [Medline].

  53. Calista D. Topical cidofovir for severe cutaneous human papillomavirus and molluscum contagiosum infections in patients with HIV/AIDS. A pilot study. J Eur Acad Dermatol Venereol. Nov 2000;14(6):484-8. [Medline].

  54. Calista D, Boschini A, Landi G. Resolution of disseminated molluscum contagiosum with Highly Active Anti-Retroviral Therapy (HAART) in patients with AIDS. Eur J Dermatol. Apr-May 1999;9(3):211-3. [Medline].

  55. Castilla MT, Sanzo JM, Fuentes S. Molluscum contagiosum in children and its relationship to attendance at swimming-pools: an epidemiological study. Dermatology. 1995;191(2):165. [Medline].

  56. Cattelan AM, Sasset L, Corti L, et al. A complete remission of recalcitrant molluscum contagiosum in an AIDS patient following highly active antiretroviral therapy (HAART). J Infect. Jan 1999;38(1):58-60. [Medline].

  57. Cronin TA Jr, Resnik BI, Elgart G. Recalcitrant giant molluscum contagiosum in a patient with AIDS. J Am Acad Dermatol. Aug 1996;35(2 Pt 1):266-7. [Medline].

  58. Dave S, Thappa DM, Karthikeyan K. Disseminated and disfiguring molluscum contagiosum in a child. Pediatr Dermatol. Sep-Oct 2003;20(5):436-9. [Medline].

  59. Davies EG, Thrasher A, Lacey K, Harper J. Topical cidofovir for severe molluscum contagiosum. Lancet. Jun 12 1999;353(9169):2042. [Medline].

  60. Dohil M, Prendiville JS. Treatment of molluscum contagiosum with oral cimetidine: clinical experience in 13 patients. Pediatr Dermatol. Jul-Aug 1996;13(4):310-2. [Medline].

  61. Epstein E. Treatment of molluscum contagiosum with griseofulvin. Schoch Letter. 1989;39:17.

  62. Garrett SJ, Robinson JK, Roenigk HH Jr. Trichloroacetic acid peel of molluscum contagiosum in immunocompromised patients. J Dermatol Surg Oncol. Oct 1992;18(10):855-8. [Medline].

  63. Gold MH, Moiin A. Treatment of verrucae vulgaris and molluscum contagiosum with photodynamic therapy. Dermatol Clin. Jan 2007;25(1):75-80. [Medline].

  64. Ha SJ, Park YM, Cho SH, et al. Solitary giant molluscum contagiosum of the sole. Pediatr Dermatol. May-Jun 1998;15(3):222-4. [Medline].

  65. Hicks CB, Myers SA, Giner J. Resolution of intractable molluscum contagiosum in a human immunodeficiency virus-infected patient after institution of antiretroviral therapy with ritonavir. Clin Infect Dis. May 1997;24(5):1023-5. [Medline].

  66. 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].

  67. Hourihane J, Hodges E, Smith J, et al. Interferon alpha treatment of molluscum contagiosum in immunodeficiency. Arch Dis Child. Jan 1999;80(1):77-9. [Medline]. [Full Text].

  68. Ibarra V, Blanco JR, Oteo JA, Rosel L. Efficacy of cidofovir in the treatment of recalcitrant molluscum contagiosum in an AIDS patient. Acta Derm Venereol. Jul-Aug 2000;80(4):315-6. [Medline].

  69. Itin PH, Lautenschlager S. Viral lesions of the mouth in HIV-infected patients. Dermatology. 1997;194(1):1-7. [Medline].

  70. Jones S, Kress D. Treatment of molluscum contagiosum and herpes simplex virus cutaneous infections. Cutis. Apr 2007;79(4 Suppl):11-7. [Medline].

  71. Kato Z, Tsubouchi K, Kondo N. Molluscum contagiosum prevents progression of staphylococcal scalded skin syndrome. Eur J Pediatr. Aug 10 2005;[Medline].

  72. Kawahara A, Yoshida M. Detection of viral DNA in nonlesional skin of patients with molluscum contagiosum and on environmental fomites. Br J Dermatol. Jun 2009;160(6):1357-9. [Medline].

  73. Kilic SS, Kilicbay F. Interferon-alpha treatment of molluscum contagiosum in a patient with hyperimmunoglobulin E syndrome. Pediatrics. Jun 2006;117(6):e1253-1255. [Medline].

  74. Kolokotronis A, Antoniades D, Katsoulidis E, Kioses V. Facial and perioral molluscum contagiosum as a manifestation of HIV infection. Aust Dent J. Mar 2000;45(1):49-52. [Medline].

  75. Lacarrubba F, Nasca MR, Micali G. Advances in the use of topical imiquimod to treat dermatologic disorders. Ther Clin Risk Manag. Feb 2008;4(1):87-97. [Medline].

  76. Lew W, Lee SH. Scalp mass. Giant molluscum contagiosum. Arch Dermatol. Jun 1995;131(6):719, 722. [Medline].

  77. Maronn M, Salm C, Lyon V, Galbraith S. One-year experience with candida antigen immunotherapy for warts and molluscum. Pediatr Dermatol. Mar-Apr 2008;25(2):189-92. [Medline].

  78. Meadows KP, Tyring SK, Pavia AT, Rallis TM. Resolution of recalcitrant molluscum contagiosum virus lesions in human immunodeficiency virus-infected patients treated with cidofovir. Arch Dermatol. Aug 1997;133(8):987-90. [Medline].

  79. Moss B, Shisler JL, Xiang Y, Senkevich TG. Immune-defense molecules of molluscum contagiosum virus, a human poxvirus. Trends Microbiol. Oct 2000;8(10):473-7. [Medline].

  80. Nunez A, Funes JM, Agromayor M, et al. Detection and typing of molluscum contagiosum virus in skin lesions by using a simple lysis method and polymerase chain reaction. J Med Virol. Dec 1996;50(4):342-9. [Medline].

  81. Ormerod AD, White MI, Shah SA, Benjamin N. Molluscum contagiosum effectively treated with a topical acidified nitrite, nitric oxide liberating cream. Br J Dermatol. Dec 1999;141(6):1051-3. [Medline].

  82. Porter CD, Blake NW, Archard LC, et al. Molluscum contagiosum virus types in genital and non-genital lesions. Br J Dermatol. Jan 1989;120(1):37-41. [Medline].

  83. Schornack MM, Siemsen DW, Bradley EA, Salomao DR, Lee HB. Ocular manifestations of molluscum contagiosum. Clin Exp Optom. Nov 2006;89(6):390-3. [Medline].

  84. Silverberg N. Pediatric molluscum contagiosum: optimal treatment strategies. Paediatr Drugs. 2003;5(8):505-12. [Medline].

  85. Singh OP, Kanwar A. Griseofulvin therapy in molluscum contagiosum. Arch Dermatol. Nov 1977;113(11):1615. [Medline].

  86. Smetana Z, Malik Z, Orenstein A, et al. Treatment of viral infections with 5-aminolevulinic acid and light. Lasers Surg Med. 1997;21(4):351-8. [Medline].

  87. Smith KJ, Skelton H. Molluscum contagiosum: recent advances in pathogenic mechanisms, and new therapies. Am J Clin Dermatol. 2002;3(8):535-45. [Medline].

  88. Smith KJ, Skelton HG, Yeager J, et al. Cutaneous findings in HIV-1-positive patients: a 42-month prospective study. Military Medical Consortium for the Advancement of Retroviral Research (MMCARR). J Am Acad Dermatol. Nov 1994;31(5 Pt 1):746-54. [Medline].

  89. Strauss RM, Doyle EL, Mohsen AH, Green ST. Successful treatment of molluscum contagiosum with topical imiquimod in a severely immunocompromised HIV-positive patient. Int J STD AIDS. Apr 2001;12(4):264-6. [Medline].

  90. Syed TA, Goswami J, Ahmadpour OA, Ahmad SA. Treatment of molluscum contagiosum in males with an analog of imiquimod 1% in cream: a placebo-controlled, double-blind study. J Dermatol. May 1998;25(5):309-13. [Medline].

  91. Thompson CH. Identification and typing of molluscum contagiosum virus in clinical specimens by polymerase chain reaction. J Med Virol. Nov 1997;53(3):205-11. [Medline].

  92. Ting PT, Dytoc MT. Therapy of external anogenital warts and molluscum contagiosum: a literature review. Dermatol Ther. 2004;17(1):68-101. [Medline].

  93. Vera-Sempere FJ, Rubio L, Massmanian A. Counts and areas of S-100-positive epidermal dendritic cells in atypical molluscum contagiosum affecting HIV+ patients. Histol Histopathol. Jan 2001;16(1):45-51. [Medline].

  94. Watanabe T, Morikawa S, Suzuki K, et al. Two major antigenic polypeptides of molluscum contagiosum virus [see comments]. J Infect Dis. Feb 1998;177(2):284-92. [Medline].

  95. Watanabe T, Nakamura K, Wakugawa M, et al. Antibodies to molluscum contagiosum virus in the general population and susceptible patients. Arch Dermatol. Dec 2000;136(12):1518-22. [Medline].

  96. Watanabe T, Tamaki K. Detection of molluscum contagiosum virus gene transcripts by in situ hybridization. J Dermatol Sci. Jun 2009;54(3):209-12. [Medline].

  97. Wheaton AF, Timothy NH, Dossett JH, Manders EK. The surgical treatment of Molluscum contagiosum in a pediatric AIDS patient. Ann Plast Surg. Jun 2000;44(6):651-5. [Medline].

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

  99. Yamashita H, Uemura T, Kawashima M. Molecular epidemiologic analysis of Japanese patients with molluscum contagiosum. Int J Dermatol. Feb 1996;35(2):99-105. [Medline].

  100. Yashar SS, Shamiri B. Oral cimetidine treatment of molluscum contagiosum. Pediatr Dermatol. Nov-Dec 1999;16(6):493. [Medline].

  101. Yoshinaga IG, Conrado LA, Schainberg SC, Grinblat M. Recalcitrant molluscum contagiosum in a patient with AIDS: combined treatment with CO(2) laser, trichloroacetic acid, and pulsed dye laser. Lasers Surg Med. 2000;27(4):291-4. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

molluscum contagiosum, MC, molluscum contagiosum virus, MCV, molluscum verrucosum, molluscum contagiosum cornutum, viral infection, Poxviridae, HIV infection, Koebner phenomenon, psoriasis, lichen planus, atopic dermatitis, sexually transmitted disease, STD, acquired immunodeficiency syndrome, AIDS, Henderson-Paterson bodies, poxvirus, keratoconjunctivitis, atopy, eczema, asthma, hayfever, epidermal cysts, nevocellular nevi, sebaceous hyperplasias, Kaposi sarcoma, sarcoidosis, lymphocytic leukemia, thymoma, orthopoxvirus, parapoxvirus, pseudocystic molluscum contagiosum, giant molluscum contagiosum, syphilis, gonorrhea

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society
Disclosure: Nothing to disclose.

Medical Editor

Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center
Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
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.