Molluscum treatment and review
January 20 2016
Molluscum contagiosum is a common viral disease of childhood presenting as small, firm, dome-shaped umbilicated papules. Although benign and generally self-limited, this condition is contagious and can lead to complications such as inflammation, pruritus, dermatitis, bacterial superinfection, and scars.
The root cause of molluscum contagiosum is a poxvirus infection that spreads by skin-to-skin contact. It takes an average of 6 months to 2 years for the host immune response to occur. “
Molluscum contagiosum is a common viral disease of childhood caused by a poxvirus, which presents with small, firm, dome-shaped, umbilicated papules. It is generally benign and self-limited, with spontaneous resolution within 6 months to several years. Watchful waiting can often be an appropriate management strategy; however, some patients either desire or require treatment.
Lancet Infect Dis. 2013. Molluscum contagiosum virus infection. MC virus is an important human skin pathogen: it can cause disfigurement and suffering in children, in adults it is less common and often sexually transmitted. Extensive and persistent skin infection with the virus can indicate underlying immunodeficiency. Traditional ablative therapies have not been compared directly with newer immune-modulating and specific antiviral therapies. Advances in research raise the prospect of new approaches to treatment informed by the biology of the virus; in human skin, the infection is localised in the epidermal layers, where it induces a typical, complex hyperproliferative lesion with an abundance of virus particles but a conspicuous absence of immune effectors. Functional studies of the viral genome have revealed effects on cellular pathways involved in the cell cycle, innate immunity, inflammation, and cell death. Extensive lesions caused by molluscum contagiosum can occur in patients with DOCK8 deficiency-a genetic disorder affecting migration of dendritic and specialised T cells in skin. Sudden disappearance of lesions is the consequence of a vigorous immune response in healthy people.
Zinc supplementation is an option. In a randomized trial, researchers who evaluated oral zinc supplementation versus placebo for two months found complete clearance in 20 out of 23 patients in the treatment group, compared with none of the 20 patients in the placebo group (Br. J. Dermatol; 2002). All patients in the zinc group reported nausea. Another placebo-controlled study of zinc sulfate 10 mg/kg per day up to 600 mg per day for up to two months (J. Am. Acad. Dermatol. 2009, showed complete clearance of all warts was achieved in 78% of patients in the treatment group, compared with 13% in the placebo group. No recurrence of warts was observed at the six-month follow-up. Nausea can limit the use of this mineral as a treatment.
Molluscum contagiosum treatment
Therapy options include curettage, cantharidin, combination of salicylic acid and lactic acid, and imiquimod. Curettage is the most efficacious treatment and has the lowest rate of side effects. Curettage must be performed with adequate anesthesia and is a time-consuming procedure. Cantharidin is a useful bloodless alternative particularly in the office setting, but has moderate complications due to blisters and necessitates more visits. Topical keratolytics salicylic acid and lactic acid are too irritating for children. Topical imiquimod holds promise but the optimum treatment schedule has yet to be determined. The ideal treatment for mollusca depends on the individual patient preference, fear, and financial status, distance from the office, and whether they have dermatitis or blood-borne infections.
Dermatol Ther (Heidelb). 2015. Molluscum Contagiosum Viral Infection Treated With a Dilute Povidone-Iodine/Dimethylsulfoxide Preparation. A 16-year-old girl presented with approximately 75 lesions on her inner thighs as a result of friction from an athletic uniform. She tried over-the-counter antibiotic ointment and topical steroids for several weeks without improvement, and was concerned at the rate of spread of the lesions, along with the social implications. The topical povidone-iodine/dimethylsulfoxide system is very effective in eradicating molluscum contagiosum.
Treatment of molluscum contagiosum with cantharidin: a
Pediatric Annals 2010
Molluscum contagiosum is very common. In this article we discuss the use of cantharidin as a treatment option for molluscum contagiosum and give detailed information about distribution sources, how to apply it, and caveats regarding its use. Reasons for actively treating molluscum contagiosum may include alleviation of discomfort and itching (particularly in patients where an eczematous eruption - the so-called "molluscum eczema" - is seen in association) or in patients with ongoing atopic dermatitis where more lesions are likely to be present. Other reasons for treatment include limitation of spread to other areas and people, prevention of scarring and superinfection, and elimination of the social stigma of visible lesions. No one treatment is uniformly effective. Treatment options include destructive therapies (curettage, cryotherapy, cantharidin, and keratolytics, among others), immunomodulators (imiquimod, cimetidine, and Candida antigen), and antivirals (cidofovir). In this article we discuss and describe our first-line treatment approach for those molluscum needing treatment - cantharidin.
One approach by a dermatologist
Dr. Sheryll L. Vanderhooft, at the 2015 annual meeting of the Pacific Dermatologic Association, said there are many options for treatment, but none of them are guaranteed to hasten resolution. Common treatment options are cryotherapy and cantharadin destruction, curettage, treatment with topical imiquimod or retinoids, oral cimetidine, and injections of Candida antigen. In Dr. Vanderhooft’s experience, Candida antigen injections benefit some patients. After injection of 0.3 mL of Candida antigen into 1 or 2 warts at monthly intervals, researchers in one study observed complete clearance in 87% of patients after an average of 3 treatments, while 7% demonstrated no improvement after an average of 3 treatments (Pediatr. Dermatol. 2008; 25: 189-92).