Molluscum contagiosum medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Molluscum contagiosum is typically a self-limiting disease and does not require treatment in all patients. Treatment may be provided in cases where the lesions are in a visible location that may be the source of social or psychological distress to the patient (e.g. face, neck, limbs, genitals). In these cases, 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 (substance)|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 | 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 supportive counseling. Molluscum contagiosum lesions usually resolve spontaneously within 2-6 months with a maximum duration of stay of years.<ref name="eMedicine" /><ref name="pmid14532898" /> Although it can resolve spontaneously, it can be a great source of embarrassment and may lead to limiting social activity in some patients.<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> | ||
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 | 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 treatment of genital lesions to prevent them from spreading.<ref name="pmid14532898" /> Bump treatment does not mean the disease is treated because the virus may still be present in the cutaneous tissue and recurrent lesions will often appear even after all the visible ones are surgically excised. As a result, multiple interventional treatment may be needed each time new lesions appear. It is recommended to examine the whole body before starting of any topical treatment to determine all visible lesions, in order to decrease the possibility of treatment failure. Typically, after a period of time, the body will develop immunity against disease. Until this is achieved, multiple skin lesion may occur.<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> | ||
=== Topical treatment choice === | === Topical treatment choice === | ||
==== Cryotherapy ==== | ==== [[Cryotherapy]] ==== | ||
* Apply liquid nitrogen with a cotton-tipped swab to the lesion for 6 to 10 seconds. | * Apply [[liquid nitrogen]] with a cotton-tipped swab to the lesion for 6 to 10 seconds. | ||
* It is a rapidly effective therapy <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> | * It is a rapidly effective therapy <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> | ||
* As it is a painful procedure, its usage is limited in young children | * As it is a painful procedure, its usage is limited in young children | ||
====== Cantharidin ====== | ====== [[Cantharidin]] ====== | ||
* It should be applied directly to lesions by physician with a cotton swab <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> | * It should be applied directly to lesions by physician with a cotton swab <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> | ||
* 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. | * 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. | ||
| Line 24: | Line 24: | ||
* Associated with some common adverse effects including transient burning, pain, [[erythema]], and [[pruritus]].. | * 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 | * 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. | * Associated with some common adverse effects including local [[erythema]], burning, [[pruritus]], [[inflammation]], and erosions. | ||
=== Other less effective treatment choices === | === Other less effective treatment choices === | ||
==== Imiquimod ==== | ==== [[Imiquimod]] ==== | ||
* It is recommended to be applied at night and washed off in the morning, but there | * It is recommended to be applied at night and washed off in the morning, but there is limited data evaluating its efficacy. | ||
==== Potassium hydroxide ==== | ==== [[Potassium hydroxide]] ==== | ||
* 5 or 10% dose concentration can be used for treatment of lesions, but there | * 5 or 10% dose concentration can be used for treatment of lesions, but there is limited data evaluating its efficacy | ||
==References== | ==References== | ||
Revision as of 17:50, 5 July 2017
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Molluscum contagiosum Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
Molluscum contagiosum is typically a self-limiting disease and does not require treatment in all patients. Treatment may be provided in cases where the lesions are in a visible location that may be the source of social or psychological distress to the patient (e.g. face, neck, limbs, genitals). In these cases, 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 supportive counseling. Molluscum contagiosum lesions usually resolve spontaneously within 2-6 months with a maximum duration of stay of years.[3][4] Although it can resolve spontaneously, it can be a great source of embarrassment and may lead to limiting social activity in some patients.[5][3][6][4]
Although there are different treatment options, there is not enough evidence of treatment efficacy for molluscum contagiosum.[7] Health professionals usually recommend treatment of genital lesions to prevent them from spreading.[4] Bump treatment does not mean the disease is treated because the virus may still be present in the cutaneous tissue and recurrent lesions will often appear even after all the visible ones are surgically excised. As a result, multiple interventional treatment may be needed each time new lesions appear. It is recommended to examine the whole body before starting of any topical treatment to determine all visible lesions, in order to decrease the possibility of treatment failure. Typically, after a period of time, the body will develop immunity against disease. Until this is achieved, multiple skin lesion may occur.[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 [10]
- 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 [11]
- 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 is limited data evaluating its efficacy.
Potassium hydroxide
- 5 or 10% dose concentration can be used for treatment of lesions, but there is limited data evaluating its efficacy
References
- ↑ Prodigy knowledgebase (2003). "Molluscum Contagiosum". National Health Service. Retrieved 2006-07-06. Unknown parameter
|month=ignored (help) - UK NHS guidelines on Molluscum Contagiosum - ↑ 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.
- ↑ 3.0 3.1 derm/270 at eMedicine
- ↑ 4.0 4.1 4.2 Tyring SK (2003). "Molluscum contagiosum: the importance of early diagnosis and treatment". Am. J. Obstet. Gynecol. 189 (3 Suppl): S12–6. PMID 14532898.
- ↑ 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.
- ↑ MedlinePlus Encyclopedia 000826
- ↑ 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.
- ↑ 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.
- ↑ "Molluscum Contagiosum - Treatment Overview". WebMD. January 12, 2007. Retrieved 2007-10-21.
- ↑ 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.
- ↑ 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.