Molluscum contagiosum medical therapy: Difference between revisions

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==Overview==
==Overview==
ontemporary treatments for MC include cryotherapy, curettage, and topical application of caustic agents. Commonly chosen treatment method of MC is “wait and see,” which usually resolves spontaneously after several months to years, but it is the great source of embarrassment, often limiting social activity.[
ontemporary treatments for MC include cryotherapy, curettage, and topical application of caustic agents. Commonly chosen treatment method of MC is “wait and see,” which usually resolves spontaneously after several months to years, but it is the great source of embarrassment, often limiting social activity.[
 
*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.
Treatment is often unnecessary<!--
Treatment is often unnecessary<!--
   --><ref name="Prodigy">{{cite web | url=http://www.prodigy.nhs.uk/molluscum_contagiosum/view_whole_guidance | title=Molluscum Contagiosum | accessdate=2006-07-06 | author=Prodigy knowledgebase | year=2003 | month=July | publisher=[[National Health Service]]}} - UK NHS guidelines on Molluscum Contagiosum</ref><!--
   --><ref name="Prodigy">{{cite web | url=http://www.prodigy.nhs.uk/molluscum_contagiosum/view_whole_guidance | title=Molluscum Contagiosum | accessdate=2006-07-06 | author=Prodigy knowledgebase | year=2003 | month=July | publisher=[[National Health Service]]}} - UK NHS guidelines on Molluscum Contagiosum</ref><!--
   --><ref name="pmid16625612">{{cite journal |author=van der Wouden JC, Menke J, Gajadin S, ''et al'' |title=Interventions for cutaneous molluscum contagiosum |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD004767 |year=2006 |pmid=16625612 |doi=10.1002/14651858.CD004767.pub2}}</ref>. Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks,<ref name="pmid10591712">{{cite journal |author=Weller R, O'Callaghan CJ, MacSween RM, White MI |title=Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation |journal=BMJ |volume=319 |issue=7224 |pages=1540 |year=1999 |pmid=10591712 |doi= |url=http://www.bmj.com/cgi/content/full/319/7224/1540}}</ref> to 2 or 3 months.<ref name="eMedicine">{{EMedicine|derm|270}}</ref> However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months,<ref name="pmid10591712">{{cite journal |author=Weller R, O'Callaghan CJ, MacSween RM, White MI |title=Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation |journal=BMJ |volume=319 |issue=7224 |pages=1540 |year=1999 |pmid=10591712 |doi= |url=http://www.bmj.com/cgi/content/full/319/7224/1540}}</ref> to about 18 months,<ref>{{MedlinePlus|000826}}</ref><ref name="pmid14532898">{{cite journal |author=Tyring SK |title=Molluscum contagiosum: the importance of early diagnosis and treatment |journal=Am. J. Obstet. Gynecol. |volume=189 |issue=3 Suppl |pages=S12–6 |year=2003 |pmid=14532898 |doi=}}</ref> and with a range of durations from 6 months to 5 years.<ref name="eMedicine" /><ref name="pmid14532898">{{cite journal |author=Tyring SK |title=Molluscum contagiosum: the importance of early diagnosis and treatment |journal=Am. J. Obstet. Gynecol. |volume=189 |issue=3 Suppl |pages=S12–6 |year=2003 |pmid=14532898 |doi=}}</ref>
   --><ref name="pmid16625612">{{cite journal |author=van der Wouden JC, Menke J, Gajadin S, ''et al'' |title=Interventions for cutaneous molluscum contagiosum |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD004767 |year=2006 |pmid=16625612 |doi=10.1002/14651858.CD004767.pub2}}</ref>. Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks,<ref name="pmid10591712">{{cite journal |author=Weller R, O'Callaghan CJ, MacSween RM, White MI |title=Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation |journal=BMJ |volume=319 |issue=7224 |pages=1540 |year=1999 |pmid=10591712 |doi= |url=http://www.bmj.com/cgi/content/full/319/7224/1540}}</ref> to 2 or 3 months.<ref name="eMedicine">{{EMedicine|derm|270}}</ref> However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months,<ref name="pmid10591712">{{cite journal |author=Weller R, O'Callaghan CJ, MacSween RM, White MI |title=Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation |journal=BMJ |volume=319 |issue=7224 |pages=1540 |year=1999 |pmid=10591712 |doi= |url=http://www.bmj.com/cgi/content/full/319/7224/1540}}</ref> to about 18 months,<ref>{{MedlinePlus|000826}}</ref><ref name="pmid14532898">{{cite journal |author=Tyring SK |title=Molluscum contagiosum: the importance of early diagnosis and treatment |journal=Am. J. Obstet. Gynecol. |volume=189 |issue=3 Suppl |pages=S12–6 |year=2003 |pmid=14532898 |doi=}}</ref> and with a range of durations from 6 months to 5 years.<ref name="eMedicine" /><ref name="pmid14532898">{{cite journal |author=Tyring SK |title=Molluscum contagiosum: the importance of early diagnosis and treatment |journal=Am. J. Obstet. Gynecol. |volume=189 |issue=3 Suppl |pages=S12–6 |year=2003 |pmid=14532898 |doi=}}</ref>
depending on the location and number of lesions, with no single approach shown to be convincingly effective.
depending on the location and number of lesions, with no single approach shown to be convincingly effective.
*Strong evidence for the efficacy of any treatment for molluscum contagiosum is lacking. No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. The update identified six new studies, most of them reporting on interventions not included in the original version. However, the conclusions of the review did not change.<ref name="pmid19821333">{{cite journal |vauthors=van der Wouden JC, van der Sande R, van Suijlekom-Smit LW, Berger M, Butler CC, Koning S |title=Interventions for cutaneous molluscum contagiosum |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD004767 |year=2009 |pmid=19821333 |doi=10.1002/14651858.CD004767.pub3 |url=}}</ref>
*The efficacy of podophyllotoxin is supported by data from a placebo-controlled randomized trial. Thus, when a trial of treatment is desired, we consider cryotherapy, curettage, cantharidin, and podophyllotoxin as first-line therapeutic options. The efficacy and safety of podophyllotoxin for molluscum contagiosum in young children have not been definitively established.
*Cryotherapy — Liquid nitrogen is used to perform cryotherapy. A cotton-tipped swab dipped in liquid nitrogen and applied to individual lesions for 6 to 10 seconds can be used to perform this technique.<ref name="pmid16445494">{{cite journal |vauthors=Brown J, Janniger CK, Schwartz RA, Silverberg NB |title=Childhood molluscum contagiosum |journal=Int. J. Dermatol. |volume=45 |issue=2 |pages=93–9 |year=2006 |pmid=16445494 |doi=10.1111/j.1365-4632.2006.02737.x |url=}}</ref>
*pain associated with cryotherapy can limit its use in young children, particularly if multiple lesions are present.<ref name="pmid19804497">{{cite journal |vauthors=Al-Mutairi N, Al-Doukhi A, Al-Farag S, Al-Haddad A |title=Comparative study on the efficacy, safety, and acceptability of imiquimod 5% cream versus cryotherapy for molluscum contagiosum in children |journal=Pediatr Dermatol |volume=27 |issue=4 |pages=388–94 |year=2010 |pmid=19804497 |doi=10.1111/j.1525-1470.2009.00974.x |url=}}</ref>
*Scarring and temporary or permanent hypopigmentation are potential adverse effects of cryotherapy. Hypopigmentation can be prominent in individuals with dark skin.
*Imiqimod5% cream seems to be slow acting but an effective agent for the treatment of MC in children.
*Curettage — Curettage involves the physical removal of the molluscum contagiosum lesion with a curette. The immediate resolution of lesions has led some clinicians to use this method as their preferred therapy for molluscum contagiosum.<ref name="pmid17156002">{{cite journal |vauthors=Hanna D, Hatami A, Powell J, Marcoux D, Maari C, Savard P, Thibeault H, McCuaig C |title=A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children |journal=Pediatr Dermatol |volume=23 |issue=6 |pages=574–9 |year=2006 |pmid=17156002 |doi=10.1111/j.1525-1470.2006.00313.x |url=}}</ref>
*The discomfort and minor bleeding associated with this procedure can be disturbing for some children, and the possibility of the development of small, depressed scars should be discussed with patients or their guardians prior to proceeding. Treatment may be time-consuming due to the need to ease children's fears about the procedure. Topical anesthetics applied prior to curettage can reduce discomfort and facilitate therapy.
*Cantharidin — Cantharidin is a topical blistering agent that is commonly used for the treatment of molluscum [39]. Treatment should be performed by a clinician; patients should not be given cantharidin to apply at home. The expected response is the development of a small blister at the treatment site, followed by disappearance of the molluscum lesion and healing without scarring.<ref name="pmid19689514">{{cite journal |vauthors=Coloe J, Morrell DS |title=Cantharidin use among pediatric dermatologists in the treatment of molluscum contagiosum |journal=Pediatr Dermatol |volume=26 |issue=4 |pages=405–8 |year=2009 |pmid=19689514 |doi=10.1111/j.1525-1470.2008.00860.x |url=}}</ref>
*Podophyllotoxin — Podophyllotoxin is an antimitotic agent


==Medical Therapy==
==Medical Therapy==

Revision as of 19:26, 9 June 2017

Molluscum contagiosum Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Molluscum contagiosum from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

History and Symptoms

Physical Examination

Laboratory Findings

X ray

Ultrasound

CT Scan

MRI

Other Imaging Studies

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

ontemporary treatments for MC include cryotherapy, curettage, and topical application of caustic agents. Commonly chosen treatment method of MC is “wait and see,” which usually resolves spontaneously after several months to years, but it is the great source of embarrassment, often limiting social activity.[

  • 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.

Treatment is often unnecessary[1][2]. Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks,[3] to 2 or 3 months.[4] However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months,[3] to about 18 months,[5][6] and with a range of durations from 6 months to 5 years.[4][6] depending on the location and number of lesions, with no single approach shown to be convincingly effective.

  • Strong evidence for the efficacy of any treatment for molluscum contagiosum is lacking. No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. The update identified six new studies, most of them reporting on interventions not included in the original version. However, the conclusions of the review did not change.[7]
  • The efficacy of podophyllotoxin is supported by data from a placebo-controlled randomized trial. Thus, when a trial of treatment is desired, we consider cryotherapy, curettage, cantharidin, and podophyllotoxin as first-line therapeutic options. The efficacy and safety of podophyllotoxin for molluscum contagiosum in young children have not been definitively established.
  • Cryotherapy — Liquid nitrogen is used to perform cryotherapy. A cotton-tipped swab dipped in liquid nitrogen and applied to individual lesions for 6 to 10 seconds can be used to perform this technique.[8]
  • pain associated with cryotherapy can limit its use in young children, particularly if multiple lesions are present.[9]
  • Scarring and temporary or permanent hypopigmentation are potential adverse effects of cryotherapy. Hypopigmentation can be prominent in individuals with dark skin.
  • Imiqimod5% cream seems to be slow acting but an effective agent for the treatment of MC in children.
  • Curettage — Curettage involves the physical removal of the molluscum contagiosum lesion with a curette. The immediate resolution of lesions has led some clinicians to use this method as their preferred therapy for molluscum contagiosum.[10]
  • The discomfort and minor bleeding associated with this procedure can be disturbing for some children, and the possibility of the development of small, depressed scars should be discussed with patients or their guardians prior to proceeding. Treatment may be time-consuming due to the need to ease children's fears about the procedure. Topical anesthetics applied prior to curettage can reduce discomfort and facilitate therapy.
  • Cantharidin — Cantharidin is a topical blistering agent that is commonly used for the treatment of molluscum [39]. Treatment should be performed by a clinician; patients should not be given cantharidin to apply at home. The expected response is the development of a small blister at the treatment site, followed by disappearance of the molluscum lesion and healing without scarring.[11]
  • Podophyllotoxin — Podophyllotoxin is an antimitotic agent

Medical Therapy

Nonetheless, treatment may be sought after for the following reasons:

  • Medical issues including:
    • Bleeding
    • Secondary infections
    • Itching and discomfort
    • Potential scarring
    • Chronic keratoconjunctivitis
  • Social reasons
    • Cosmetic
    • Embarrassment
    • Fear of transmission to others
    • Social exclusion

Many health professionals recommend treating bumps located in the genital area to prevent them from spreading.[6] It is important to realize that treating the bumps does not cure the disease. The virus is in the skin and new bumps will often appear even after all the visible ones are surgically treated. Any surgical option of treatment may therefore have to be repeated each time new bumps occur. The body eventually mounts an effective immune response and rids itself of the virus, but until then, new bumps may occur over the course of a year or more.

Betadine

There are a few treatment options that can be done at home. Betadine surgical scrub can be gently scrubbed on the infected area for 5 minutes daily until the lesions resolve (this is not recommended for those allergic to iodine or betadine). However, the ability of iodine to penetrate intact skin is poor, and without a pin prick or needle stick into each molluscum lesion this method does not work well. Do not use on broken skin.

Astringents

Astringent chemicals applied to the surface of molluscum lesions to destroy successive layers of the skin include trichloroacetic acid, podophyllin resin, potassium hydroxide, and cantharidin.[12]

Australian Lemon Myrtle

A 2004 study demonstrated over 90% reduction in the number of lesions in 9 out of 16 children treated with 10% strength solution of essential oil of Australian lemon myrtle (Backhousia citriodora).[13] However the oil may irritate normal skin at concentrations of 1%.[14][15]

Over-the-counter substances

For mild cases, over-the-counter wart medicines, such as salicylic acid may shorten infection duration. Daily topical application of tretinoin cream ("Retin-A 0.025%") may also trigger resolution.[16][17] These treatments require several months for the infection to clear, and are often associated with intense inflammation and possibly discomfort.

Imiquimod

Doctors occasionally prescribe Imiquimod, the optimum schedule for its use has yet to be established.[10]Imiquimod, a form of immunotherapy. Immunotherapy triggers your immune system to fight the virus causing the skin growth. Imiquimod is applied 3 times per week, left on the skin for 6 to 10 hours, and washed off. A course may last from 4 to 16 weeks. Small studies have indicated that it is successful about 80% of the time

Non-medicine Treatment

The infection can also be cleared without medicine if there are only a few lesions. First, the affected skin area should be cleaned with an alcohol swab. Next, a sterile needle is used to cut across the head of the lesion, through the central dimple. The contents of the papule are removed with another alcohol swab. This procedure is repeated for each lesion (and is therefore unreasonable for a large infection). With this method, the lesions will heal in two to three days.

References

  1. ↑ Prodigy knowledgebase (2003). "Molluscum Contagiosum". National Health Service. Retrieved 2006-07-06. Unknown parameter |month= ignored (help) - UK NHS guidelines on Molluscum Contagiosum
  2. ↑ van der Wouden JC, Menke J, Gajadin S; et al. (2006). "Interventions for cutaneous molluscum contagiosum". Cochrane Database Syst Rev (2): CD004767. doi:10.1002/14651858.CD004767.pub2. PMID 16625612.
  3. ↑ 3.0 3.1 Weller R, O'Callaghan CJ, MacSween RM, White MI (1999). "Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation". BMJ. 319 (7224): 1540. PMID 10591712.
  4. ↑ 4.0 4.1 derm/270 at eMedicine
  5. ↑ MedlinePlus Encyclopedia 000826
  6. ↑ 6.0 6.1 6.2 Tyring SK (2003). "Molluscum contagiosum: the importance of early diagnosis and treatment". Am. J. Obstet. Gynecol. 189 (3 Suppl): S12–6. PMID 14532898.
  7. ↑ van der Wouden JC, van der Sande R, van Suijlekom-Smit LW, Berger M, Butler CC, Koning S (2009). "Interventions for cutaneous molluscum contagiosum". Cochrane Database Syst Rev (4): CD004767. doi:10.1002/14651858.CD004767.pub3. PMID 19821333.
  8. ↑ Brown J, Janniger CK, Schwartz RA, Silverberg NB (2006). "Childhood molluscum contagiosum". Int. J. Dermatol. 45 (2): 93–9. doi:10.1111/j.1365-4632.2006.02737.x. PMID 16445494.
  9. ↑ Al-Mutairi N, Al-Doukhi A, Al-Farag S, Al-Haddad A (2010). "Comparative study on the efficacy, safety, and acceptability of imiquimod 5% cream versus cryotherapy for molluscum contagiosum in children". Pediatr Dermatol. 27 (4): 388–94. doi:10.1111/j.1525-1470.2009.00974.x. PMID 19804497.
  10. ↑ 10.0 10.1 Hanna D, Hatami A, Powell J, Marcoux D, Maari C, Savard P, Thibeault H, McCuaig C (2006). "A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children". Pediatr Dermatol. 23 (6): 574–9. doi:10.1111/j.1525-1470.2006.00313.x. PMID 17156002.
  11. ↑ Coloe J, Morrell DS (2009). "Cantharidin use among pediatric dermatologists in the treatment of molluscum contagiosum". Pediatr Dermatol. 26 (4): 405–8. doi:10.1111/j.1525-1470.2008.00860.x. PMID 19689514.
  12. ↑ "Molluscum Contagiosum - Treatment Overview". WebMD. January 12, 2007. Retrieved 2007-10-21.
  13. ↑ Burke BE, Baillie JE, Olson RD (2004). "Essential oil of Australian lemon myrtle (Backhousia citriodora) in the treatment of molluscum contagiosum in children". Biomed. Pharmacother. 58 (4): 245–7. doi:10.1016/j.biopha.2003.11.006. PMID 15183850.
  14. ↑ Hayes AJ, Markovic B (2002). "Toxicity of Australian essential oil Backhousia citriodora (Lemon myrtle). Part 1. Antimicrobial activity and in vitro cytotoxicity". Food Chem. Toxicol. 40 (4): 535–43. PMID 11893412.
  15. ↑ Hayes AJ, Markovic B (2003). "Toxicity of Australian essential oil Backhousia citriodora (lemon myrtle). Part 2. Absorption and histopathology following application to human skin". Food Chem. Toxicol. 41 (10): 1409–16. PMID 12909275.
  16. ↑ Papa C, Berger R (1976). "Venereal herpes-like molluscum contagiosum: treatment with tretinoin". Cutis. 18 (4): 537–40. PMID 1037097.
  17. ↑ "Molluscum Contagiosum". Adolesc Med. 7 (1): 57–62. 1996. PMID 10359957.

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