Molluscum contagiosum medical therapy

Molluscum contagiosum Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The mainstay of therapy for molluscum contagiosum is topical treatment. Contemporary topical medical therapies for molluscum contagiosum include cryotherapy, curettage, and topical application of caustic agents.

Medical therapy

Molluscum contagiosum (MC) is a self limited disease. Treatment is often unnecessary. The most common chosen treatment method for MC is observational and sonservative. Molluscum contagiosum lesions usually resolves spontaneously after 2-6 months with a maximum duration of stay of years. Although it can be resolved spontaneously, it can be a great source of embarrassment and lead to limiting social activity. The range can even be more and extend to a range of durations from 6 months to 5 years.

Although there are different treatment options, there is not enough evidence of treatment efficacy for molluscum contagiosum.

• Cryotherapy with liquid nitrogen.
• Benzoyl peroxide cream. (There is limited evidence of efficacy in the Cochrane review.)
• Sodium nitrate co-applied with salicylic acid. (There is limited evidence of efficacy in the Cochrane review.)
• Potassium hydroxide 5% or 10% topical solutions. There is no statistical significance to benefit in the Cochrane review. These are available to prescribe as medical devices in the UK (meaning less stringent evaluation is required than for a licensed medicine) as MolluDab® and Molutrex® but, as evidence is so limited and they are available to buy over the counter, many areas advise against prescribing.
• Iodine preparations.
• Hydrogen peroxide 1% cream (available to prescribe as Crystacide® in the UK).
• Imiquimod 5% cream. (No convincing benefit was found in healthy individuals in the Cochrane review; however, this has been used in immunocompromised people.)
• Pulsed dye laser.

contemporary treatments for MC include cryotherapy, curettage, and topical application of caustic agents. [

• Strong evidence for the efficacy of any treatment for molluscum contagiosum is lacking.
• The efficacy of podophyllotoxin is supported by data from a placebo-controlled randomized trial. Thus, when a trial of treatment is desired, we consider cryotherapy, curettage, cantharidin, and podophyllotoxin as first-line therapeutic options. The efficacy and safety of podophyllotoxin for molluscum contagiosum in young children have not been definitively established.
• Cryotherapy — Liquid nitrogen is used to perform cryotherapy. A cotton-tipped swab dipped in liquid nitrogen and applied to individual lesions for 6 to 10 seconds can be used to perform this technique.
• pain associated with cryotherapy can limit its use in young children, particularly if multiple lesions are present.
• Scarring and temporary or permanent hypopigmentation are potential adverse effects of cryotherapy. Hypopigmentation can be prominent in individuals with dark skin.
• Imiqimod5% cream seems to be slow acting but an effective agent for the treatment of MC in children.
• Curettage — Curettage involves the physical removal of the molluscum contagiosum lesion with a curette. The immediate resolution of lesions has led some clinicians to use this method as their preferred therapy for molluscum contagiosum.
• The discomfort and minor bleeding associated with this procedure can be disturbing for some children, and the possibility of the development of small, depressed scars should be discussed with patients or their guardians prior to proceeding. Treatment may be time-consuming due to the need to ease children's fears about the procedure. Topical anesthetics applied prior to curettage can reduce discomfort and facilitate therapy.
• Cantharidin — Cantharidin is a topical blistering agent that is commonly used for the treatment of molluscum [39]. Treatment should be performed by a clinician; patients should not be given cantharidin to apply at home. The expected response is the development of a small blister at the treatment site, followed by disappearance of the molluscum lesion and healing without scarring.
• Podophyllotoxin — Podophyllotoxin is an antimitotic agent

Medical Therapy

Nonetheless, treatment may be sought after for the following reasons:

• Medical issues including:
  • Bleeding
  • Secondary infections
  • Itching and discomfort
  • Potential scarring
  • Chronic keratoconjunctivitis
• Social reasons
  • Cosmetic
  • Embarrassment
  • Fear of transmission to others
  • Social exclusion

Health professionals usually recommend to treat genital lesions to prevent them from spreading. Bump treatment doesn't mean the disease is treated as well because the virus is still in the cutaneous tissue and new bumps will often appear even after all the visible ones are surgically treated. As a result, multiple interventional treatment may be needed each time new bumps occur. Usually after a period of time the body can immune itself from the disease but during the immunization, multiple skin lesion may occur which all needed treatment as well.

Betadine

There are a few treatment options that can be done at home. Betadine surgical scrub can be gently scrubbed on the infected area for 5 minutes daily until the lesions resolve (this is not recommended for those allergic to iodine or betadine). However, the ability of iodine to penetrate intact skin is poor, and without a pin prick or needle stick into each molluscum lesion this method does not work well. Do not use on broken skin.

Astringents

Astringent chemicals applied to the surface of molluscum lesions to destroy successive layers of the skin include trichloroacetic acid, podophyllin resin, potassium hydroxide, and cantharidin.

Australian Lemon Myrtle

A 2004 study demonstrated over 90% reduction in the number of lesions in 9 out of 16 children treated with 10% strength solution of essential oil of Australian lemon myrtle (Backhousia citriodora). However the oil may irritate normal skin at concentrations of 1%.

Over-the-counter substances

For mild cases, over-the-counter wart medicines, such as salicylic acid may shorten infection duration. Daily topical application of tretinoin cream ("Retin-A 0.025%") may also trigger resolution. These treatments require several months for the infection to clear, and are often associated with intense inflammation and possibly discomfort.

Imiquimod

Doctors occasionally prescribe Imiquimod, the optimum schedule for its use has yet to be established.Imiquimod, a form of immunotherapy. Immunotherapy triggers your immune system to fight the virus causing the skin growth. Imiquimod is applied 3 times per week, left on the skin for 6 to 10 hours, and washed off. A course may last from 4 to 16 weeks. Small studies have indicated that it is successful about 80% of the time

Non-medicine Treatment

The infection can also be cleared without medicine if there are only a few lesions. First, the affected skin area should be cleaned with an alcohol swab. Next, a sterile needle is used to cut across the head of the lesion, through the central dimple. The contents of the papule are removed with another alcohol swab. This procedure is repeated for each lesion (and is therefore unreasonable for a large infection). With this method, the lesions will heal in two to three days.