Molluscum contagiosum medical therapy: Difference between revisions

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==Overview==
==Overview==
The mainstay of therapy for molluscum contagiosum is topical treatment. Contemporary topical medical therapies for molluscum contagiosum include cryotherapy, curettage, and topical application of caustic agents.
The mainstay of therapy for molluscum contagiosum is topical treatment. Contemporary topical medical therapies for molluscum contagiosum include [[cryotherapy]], [[curettage]], and topical application of caustic agents.


== Medical therapy ==
== Medical therapy ==
Molluscum contagiosum (MC) is a self limited disease. 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="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>. The most common chosen treatment method for MC is observational and sonservative. Molluscum contagiosum lesions usually resolves spontaneously after 2-6 months with a maximum duration of stay of years. Although it can be resolved spontaneously, it can be a great source of embarrassment and lead to limiting social activity.<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><ref name="eMedicine">{{EMedicine|derm|270}}</ref><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> The range can even be more and extend to a range of durations from 6 months to 5 years.<ref name="eMedicine" /><ref name="pmid14532898" />
Molluscum contagiosum (MC) is a self limited disease. 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="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>. The most common chosen treatment method for MC is observational and conservative. Molluscum contagiosum lesions usually resolves spontaneously after 2-6 months with a maximum duration of stay of years. Although it can be resolved spontaneously, it can be a great source of embarrassment and lead to limiting social activity.<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><ref name="eMedicine">{{EMedicine|derm|270}}</ref><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> The range can even be more and extend to a range of durations from 6 months to 5 years.<ref name="eMedicine" /><ref name="pmid14532898" />


Although there are different treatment options, there is not enough evidence of treatment efficacy for molluscum contagiosum.<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>
Although there are different treatment options, there is not enough evidence of treatment efficacy for molluscum contagiosum.<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> Health professionals usually recommend to treat genital lesions to prevent them from spreading.<ref name="pmid14532898" /> Bump treatment doesn't mean the disease is treated as well because the virus is still in the cutaneous tissue and new bumps will often appear even after all the visible ones are surgically treated. As a result, multiple interventional treatment may be needed each time new bumps occur. It is recommended to examine all the body before starting of any topical treatment to determine all visible lesions, in order to decrease the possibility of treatment failure. Usually after a period of time the body can immune itself from the disease but during the [[immunization]], multiple skin lesion may occur which all needed treatment as well.<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><ref>{{cite web |title=Molluscum Contagiosum - Treatment Overview |url=http://www.webmd.com/skin-problems-and-treatments/tc/molluscum-contagiosum-treatment-overview |date=January 12, 2007 |publisher=WebMD |accessdate=2007-10-21}}</ref>
* Cryotherapy with liquid nitrogen.
* Benzoyl peroxide cream. (There is limited evidence of efficacy in the Cochrane review.)
* Sodium nitrate co-applied with salicylic acid. (There is limited evidence of efficacy in the Cochrane review.)
* Potassium hydroxide 5% or 10% topical solutions. There is no statistical significance to benefit in the Cochrane review. These are available to prescribe as medical devices in the UK (meaning less stringent evaluation is required than for a licensed medicine) as MolluDab® and Molutrex® but, as evidence is so limited and they are available to buy over the counter, many areas advise against prescribing.
* Iodine preparations.
* Hydrogen peroxide 1% cream (available to prescribe as Crystacide® in the UK).
* Imiquimod 5% cream. (No convincing benefit was found in healthy individuals in the Cochrane review; however, this has been used in immunocompromised people.)
* Pulsed dye laser.
contemporary treatments for MC include cryotherapy, curettage, and topical application of caustic agents. [


*Strong evidence for the efficacy of any treatment for molluscum contagiosum is lacking.
=== Topical treatment choice ===
*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==
==== Cryotherapy ====
Nonetheless, treatment may be sought after for the following reasons:
* Apply liquid nitrogen with a cotton-tipped swab to the lesion for 6 to 10 seconds.
*Medical issues including:
* It is a rapidly effective therapy 19804497
**Bleeding
* As it is a painful procedure, its usage is limited in young children
**Secondary infections
**Itching and discomfort
**Potential scarring
**Chronic keratoconjunctivitis
*Social reasons
**Cosmetic
**Embarrassment
**Fear of transmission to others
**Social exclusion


Health professionals usually recommend to treat genital lesions to prevent them from spreading.<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> Bump treatment doesn't mean the disease is treated as well because the virus is still in the cutaneous tissue and new bumps will often appear even after all the visible ones are surgically treated. As a result, multiple interventional treatment may be needed  each time new bumps occur. Usually after a period of time the body can immune itself from the disease but during the immunization, multiple skin lesion may occur which all needed treatment as well.
====== Cantharidin ======
* It should be applied directly to lesions by physician with a cotton swab 19689514
* It should stay on the skin with a bandage and washed off with soap and water 2-6 hours after application or when the first sign of blistering appeared.
* Treatment should be avoided on the face, genital, or perianal areas.
* Associated with some common adverse effects including transient burning, pain, [[erythema]], and [[pruritus]]..


===Betadine===
==== Podophyllotoxin ====
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.
* It is available as an [[antimitotic agent]] that is commercially available as podofilox 0.5% (Condylox) in a solution or gel.
* Associated with some common adverse effects including local [[erythema]], burning, [[pruritus]], [[inflammation]], and erosions.


===Astringents===
=== Other less effective treatment choices ===
[[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]].<ref>{{cite web |title=Molluscum Contagiosum - Treatment Overview |url=http://www.webmd.com/skin-problems-and-treatments/tc/molluscum-contagiosum-treatment-overview |date=January 12, 2007 |publisher=WebMD |accessdate=2007-10-21}}</ref>


===Australian Lemon Myrtle===
==== Imiquimod ====
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]]'').<ref name="pmid15183850">{{cite journal |author=Burke BE, Baillie JE, Olson RD |title=Essential oil of Australian lemon myrtle (Backhousia citriodora) in the treatment of molluscum contagiosum in children |journal=Biomed. Pharmacother. |volume=58 |issue=4 |pages=245–7 |year=2004 |pmid=15183850 |doi=10.1016/j.biopha.2003.11.006}}</ref> However the oil may irritate normal skin at concentrations of 1%.<ref name="pmid11893412">{{cite journal |author=Hayes AJ, Markovic B |title=Toxicity of Australian essential oil Backhousia citriodora (Lemon myrtle). Part 1. Antimicrobial activity and in vitro cytotoxicity |journal=Food Chem. Toxicol. |volume=40 |issue=4 |pages=535–43 |year=2002 |pmid=11893412 |doi=}}</ref><ref name="pmid12909275">{{cite journal |author=Hayes AJ, Markovic B |title=Toxicity of Australian essential oil Backhousia citriodora (lemon myrtle). Part 2. Absorption and histopathology following application to human skin |journal=Food Chem. Toxicol. |volume=41 |issue=10 |pages=1409–16 |year=2003 |pmid=12909275 |doi=}}</ref>
* It is recommended to be applied at night and washed off in the morning, but there are very few data cosidering its efficacy.


===Over-the-counter substances===
==== Potassium hydroxide ====
For mild cases, [[Over-the-counter substance|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.<!--
* 5 or 10% dose concentration can be used for treatment of lesions,  but there are very few data cosidering its efficacy
  --><ref>{{cite journal |author=Papa C, Berger R |title=Venereal herpes-like molluscum contagiosum: treatment with tretinoin |journal=Cutis |volume=18 |issue=4 |pages=537-40 |year=1976 |id=PMID 1037097}}</ref><!--
  --><ref>{{cite journal |author= |title=Molluscum Contagiosum |journal=Adolesc Med |volume=7 |issue=1 |pages=57-62 |year=1996 |id=PMID 10359957}}</ref> 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.<ref name="pmid17156002">{{cite journal |author=Hanna D, Hatami A, Powell J, ''et al'' |title=A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children |journal=Pediatric dermatology |volume=23 |issue=6 |pages=574-9 |year=2006 |pmid=17156002 |doi=10.1111/j.1525-1470.2006.00313.x}}</ref>[[ 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==
==References==

Revision as of 11:51, 13 June 2017

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

Overview

The mainstay of therapy for molluscum contagiosum is topical treatment. Contemporary topical medical therapies for molluscum contagiosum include cryotherapy, curettage, and topical application of caustic agents.

Medical therapy

Molluscum contagiosum (MC) is a self limited disease. Treatment is often unnecessary[1][2]. The most common chosen treatment method for MC is observational and conservative. Molluscum contagiosum lesions usually resolves spontaneously after 2-6 months with a maximum duration of stay of years. Although it can be resolved spontaneously, it can be a great source of embarrassment and lead to limiting social activity.[3][4][5][6] The range can even be more and extend to a range of durations from 6 months to 5 years.[4][6]

Although there are different treatment options, there is not enough evidence of treatment efficacy for molluscum contagiosum.[7] Health professionals usually recommend to treat genital lesions to prevent them from spreading.[6] Bump treatment doesn't mean the disease is treated as well because the virus is still in the cutaneous tissue and new bumps will often appear even after all the visible ones are surgically treated. As a result, multiple interventional treatment may be needed each time new bumps occur. It is recommended to examine all the body before starting of any topical treatment to determine all visible lesions, in order to decrease the possibility of treatment failure. Usually after a period of time the body can immune itself from the disease but during the immunization, multiple skin lesion may occur which all needed treatment as well.[8][9]

Topical treatment choice

Cryotherapy

  • Apply liquid nitrogen with a cotton-tipped swab to the lesion for 6 to 10 seconds.
  • It is a rapidly effective therapy 19804497
  • As it is a painful procedure, its usage is limited in young children
Cantharidin
  • It should be applied directly to lesions by physician with a cotton swab 19689514
  • It should stay on the skin with a bandage and washed off with soap and water 2-6 hours after application or when the first sign of blistering appeared.
  • Treatment should be avoided on the face, genital, or perianal areas.
  • Associated with some common adverse effects including transient burning, pain, erythema, and pruritus..

Podophyllotoxin 

  • It is available as an antimitotic agent that is commercially available as podofilox 0.5% (Condylox) in a solution or gel.
  • Associated with some common adverse effects including local erythema, burning, pruritus, inflammation, and erosions.

Other less effective treatment choices

Imiquimod

  • It is recommended to be applied at night and washed off in the morning, but there are very few data cosidering its efficacy.

Potassium hydroxide

  • 5 or 10% dose concentration can be used for treatment of lesions, but there are very few data cosidering its efficacy

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. ↑ 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. ↑ 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.
  9. ↑ "Molluscum Contagiosum - Treatment Overview". WebMD. January 12, 2007. Retrieved 2007-10-21.

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