Molluscum%20contagiosum Treatment

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

The role of oral antivirals in COVID-19 treatment: Who, when, and how?

Dr. Roger Paredes, Dr. Nicola Petrosillo, Dr. Petrick Periyasamy, 30 Jan 2023

Though most countries have eased pandemic restrictions, there is no room for complacency in managing COVID-19, which continues to cause significant morbidity and mortality.

At a recent symposium, esteemed experts Dr Roger Paredes, Head of Department of Infectious Diseases at the Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain, and Dr Nicola Petrosillo, Head of the Infection Prevention and Control and Infectious Disease Service at University Hospital Campus Bio-Medico, Rome, Italy, gave global perspectives on the continuing unmet needs in the COVID-19 outpatient landscape and discussed the role of antiviral treatment options in patients at risk of progressing to severe COVID-19. Dr Petrick Periyasamy, Head of Infectious Diseases Unit, Medical Department, UKM Medical Centre, Kuala Lumpur, Malaysia, chaired the session.

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