Management

Often no specific treatment is required - this is a self-limiting infection and it may resolve spontaneously in 6-9 months (but some cases may persist up to 4 years) (1).

Patients should be educated about prevention of spread of the disease - by use of separate towels and other measures of basic hygiene (1).

Treatment options, if required, include

• cryotherapy – application of liquid nitrogen to the lesion
• expression of the contents of the pearly core (manually or using forceps)
• piercing with an orange stick , with or without the application of tincture of iodine or phenol
• curettage or diathermy (2)
• itching might be a problem for the patient and may require an emollient and a mild topical corticosteroid (e.g. hydrocortisone 1%) (1).

Other treatment options that have been employed include:

• topical 0.5% podophyllotoxin (applied to lesions twice a day for 3 consecutive days and repeated weekly cycles until the lesions cleared) (contraindicated in pregnant and breast feeding women) (2,3)
• home-applied imiquimod 5% cream
  • a small pilot study has shown a 33.3% complete clearance after 12 weeks treatment of childhood molloscum contagiosum (2)
• 5% potassium hydroxide solution - Molludab - is available as an OTC preparation
  • there is study evidence that a 5% potassium hydroxide solution is more effective than a 2.5% solution (7)
  • potassium hydroxide 10% and 15% demonstrated high rates of efficacy in clearing Molluscum contagiosum lesions, with potassium hydroxide 10% being better tolerated (8)

However a systematic review concluded that "..no single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. We found moderate-quality evidence that topical 5% imiquimod was no more effective than vehicle in terms of clinical cure, but led to more application site reactions.." (9)

Eczema around the lesion can be treated with emollients, 1% ichthammol paste or mild topical or mild topical steroid (5)

For ano-genital molluscum contagiosum:

• podophyllotoxin paint once weekly can be used
• consider referring adults to genitourinary medicine for infection screen (5)

Highly active antiretroviral therapy may be necessary in HIV patients for the resolution of the disease (2).

Recurrences of the disease are common and the patient should be educated about reappearance of lesions and treatment failure before starting treatment (6).

A more aggressive, widespread form occurs in immunocompromised patients.

Criteria for referral to a secondary care facility:

• diagnostic uncertainty
• extensive, painful, inflamed lesions
• immunosuppressed patients

If there is associated conjunctivitis the patient should be referred to an ophthalmologist (5)

Reference:

• (1) Primary Care Dermatology Society 2009. Molluscum contagiosum
• (2)British Association of Sexual Health and HIV 2007. United Kingdom national guideline on the management of Molluscum contagiosum
• (3) 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;189:65-8.
• (4) Theos AU et al. Effectiveness of imiquimod cream 5% for treating childhood molluscum contagiosum in a double-blind, randomized pilot trial. Cutis. 2004 Aug;74(2):134-8, 141-2.
• (5) NHS Scotland. Molluscum Contagiosum Patient Pathway draft
• (6) Smolinski KN, Yan AC. How and when to treat molluscum contagiosum and warts in children. Pediatr Ann. 2005;34(3):211-21
• (7) Ucmak D et al. Comparative study of 5% and 2.5% potassium hydroxide solution for molluscum contagiosum in children. Cutan Ocul Toxicol. 2014 Mar;33(1):54-9
• (8) Teixido C et al. Efficacy and safety of topical application of 15% and 10% potassium hydroxide for the treatment of Molluscum contagiosum.Pediatr Dermatol. 2018 May;35(3):336-342
• (9) van der Wouden JC et al. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2017 May 17;5:CD004767