Molluscum contagiosum is a pox virus. Infection of the skin is self-limiting, over weeks to months and occasionally up to a year, and is associated with eczema in susceptible individuals.1 Lesions are easily spread through auto-inoculation via shaving and picking.
Treatment is not necessarily needed and may be associated with scarring or post-inflammatory pigmentation change in the skin.2 Treatments may be categorised as nil, those that are locally traumatic or irritant, antiviral therapies and immune modulating medications.2
In adults and older children, cryotherapy and direct curettage of the central core of each lesion are the most common treatments and should be done under medical supervision. Curettage has been cited as the most effective and safe treatment option overall.2
There are a number of irritant substances that have been used to induce resolution of molluscum contagiosum. These include tretinoin, benzyl peroxide, silver nitrate, salicylic acid, glycolic acid and cantharidin (cantharidin is contraindicated in pregnant women).2 Podophyllotoxin cream (0.5%) may be applied to the individual lesions, but may cause irritation of the surrounding skin, and, if used incorrectly, scarring.3
Younger children may not tolerate cryotherapy, nor the removal of the central core of each lesion. The application of duct tape or sticking plaster firmly over the central core in particular for two days, and then ripping it off, has been used successfully.1 The irritation and shearing effect increases the likelihood of resolution of the lesions, but contact dermatitis from the plaster may be a side-effect. The application of benzyl peroxide 5% or tretinoin cream prior to the plaster (for one day instead of two) further increases the success rate, but also the risk of dermatitis.1
Extensive molluscum contagiosum infection, as occurs in immunosuppressed individuals, may require antiviral treatment or immune modulators such as imiquimod. However, imiquimod is expensive, its use in this setting is off-label and the duration of necessary treatment is currently undecided. Oral cimetidine is known to have immune modulating effects on the virus in children, but facial lesions do not respond as well as other regions.3 Treatment of the underlying immune deficiency aids management of the pox infection.
Strict attention to hygiene is very important. Those with molluscum infection should do the following:
(The Author’s modified version of Kids’ Health Info, Royal Children’s Hospital Melbourne)1
1. Dermatology Department, Molluscum, Royal Children’s Hospital Melbourne, November 2010
2. Bhatia, A. C. Molluscum Contagiosum Treatment & Management Medscape, 17 Nov 2015
3. Centres for Disease Control and Prevention, Molluscum Contagiosum: Treatment Options, 11 May 2015