Molluscum%20contagiosum Treatment
Pharmacotherapy
Topical Agents
Cantharidin
- Actions: Protein phosphatase inhibitor that penetrates the epidermis & induces blistering through acantholysis
- Effects: One study showed clearance of 90% of lesions
- Advantages: Effective treatment
- Disadvantages: May cause temporary burning, risk of blistering, pruritus, infection, repeated office visits are needed
- Should not be used on the face, genital/perianal area
Cidofovir
- Case studies has shown clearance of lesions in immunocompromised individuals & in patients suffering from recalcitrant lesions
- May also be administered intravenously in immunocompromised patients
- Advantages: Effective treatment
- Disadvantages: High cost, need for extemporaneous preparation; currently only available as solution for injection
Imiquimod
- Actions: Topical immune response modifier that produces localized immune response at the site of application
- Effects: 75-82% of patients treated experienced clearance of lesions
- Advantages: Effective in the majority of cases treated, well tolerated
- Disadvantages: High cost, irritation at application site, flu-like symptoms may occur
- Studies proving efficacy are still lacking
Iodine Tincture
- Apply directly to lesion or apply after puncturing each papule w/ sterile needle or by curettage
- Advantages: Reported to be safe & effective
Iodine + Salicylic Acid
- Advantages: Reported to be effective
- Disadvantages: May cause maceration & erosion
Podophyllotoxin
- Effects: Small study showed 92% of patients treated experienced clearance of lesions
- Advantages: Shown to be effective
- Disadvantages: May cause burning, erosions, itching & erythema
- Severe systemic effect on overdosage
Potassium Hydroxide (KOH)
- Advantages: Reported to be effective
- Disadvantages: Painful, may scar, hypo- & hyperpigmentation may occur
- Studies proving efficacy are still lacking
Salicylic Acid w/ or w/o Lactic Acid
- Advantages: Well-tolerated, easily applied
- Disadvantages: Irritation may occur
Tretinoin
- Advantages: Well-tolerated, easily applied
- Disadvantages: Variable efficacy
- Studies proving efficacy are limited
Trichloroacetic acid
- Advantages: Causes less local irritation & systemic toxicity than other acids in its class
- Disadvantages: Responses is often incomplete & recurrence frequently occurs
Systemic Agents
Cimetidine (Oral)
- Actions: Stimulates delayed-type hypersensitivity
- Effects: 1 small study showed resolution in 9 out of 13 patients treated
- Advantages: Safe, painless, well-tolerated esp by childn, easy to administer
- Disadvantages: Efficacy is variable & more studies are needed
- Facial lesions often unresponsive
- Potential of systemic side effects & drug interactions
Other Treatments
Interferon alpha
- Alternative treatment for immunocompromised patients w/ severe, refractory MC
- Administered subcutaneously; may also be given intralesionally
- Influenza-like symptoms may occur
Non-Pharmacological Therapy
No Treatment
- In immunocompetent hosts, MC is a self-limited disease, which when left untreated eventually resolves after 6 mth up to 5 yr
- Individual lesions may resolve spontaneously w/in 2 mth & completely disappear in 6-12 mth
- New lesions can develop w/ autoinoculation
- Advantages: No scarring, not painful
- Disadvantages: May transfer virus to other individuals or continue to spread to self w/ autoinoculation
Cryotherapy
- Liquid nitrogen is applied to each lesion for a few seconds
- Advantages: Effective treatment
- Disadvantages: Painful, risk of blistering, risk of hyper- or hypopigmentation & scarring, multiple clinic visits may be necessary
Evisceration/Curettage
- Mechanical removal of the core of the lesion; scalpel, edge of glass slide, etc may be used to remove umbilicated core
- 2-4 mm curette may also be used to “flick” off the papule
- Advantages: Effective treatment, immediate results
- Disadvantages: Painful, risk of spread, scarring, bleeding, multiple office visits may be necessary
- Topical anesthetic cream should be applied prior to treatment
- May not be tolerated by small children