Therapeutic Approaches and Special Considerations for Treating Molluscum Contagiosum

November 2021 | Volume 20 | Issue 11 | Original Article | 1185 | Copyright © November 2021


Published online October 20, 2021

Lawrence F. Eichenfield MDa, Adelaide A. Hebert MDb, Anthony J. Mancini MDc, Theodore Rosen MDd, Jonathan Weiss MDe

aRady Children's Hospital-San Diego and Departments of Dermatology and Pediatrics, University of California San Diego School of Medicine, San Diego, CA
bUniversity of Texas Health Science Center Houston, Houston, TX
cAnn & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL
dDepartment of Dermatology, Baylor College of Medicine, Houston, TX
eGwinnett Clinical Research Center, Inc., Snellville, GA

Abstract
Molluscum contagiosum (molluscum) is a common skin condition, especially in children, yet treatment approaches by US health care practitioners vary widely. A dearth of clinical data from large, well-controlled studies has resulted in significant gaps in knowledge, including treatment guidelines and algorithms. As of this writing, there are no FDA-approved treatments for molluscum.

The objective of this review is to provide practitioners with expert, evidence-based information and guidance about treatment approaches for, and the special circumstances faced by, patients with molluscum. To this end, a group of five pediatric and adult dermatologists collectively identified treatments and special considerations they felt were most commonly used to treat molluscum. Hence, in the first part of the review, seven treatment approaches identified as the most important to review (e.g., curettage, cantharidin) are discussed in terms of their mechanisms of action, supporting clinical data, and rationale for use. Each treatment approach concludes with a “clinical pearls” section, which summarizes the group’s experiences with the treatment. In the second part, five special considerations (e.g., atopic dermatitis, skin of color) are discussed with supporting clinical data and are also followed by a “clinical pearls” summary.

J Drugs Dermatol. 2021;20(11): 1185-1190. doi:10.36849/JDD.6383

INTRODUCTION

Molluscum contagiosum (molluscum) is the third most common viral skin infection in children and one of the five most prevalent skin diseases worldwide.1,2 Molluscum primarily affects children, the immunocompromised, and sexually active adults,3 with the greatest incidence in children between the ages of 1 and 14.4 While prevalence rates vary widely in the literature, best estimates range between 5.1% and 11.5%.5

Frequently described as “benign” and “self-limiting,” molluscum is often perceived as a mild, short-lived illness that can be waited out. This perception is being challenged as new data about prognosis and impact on quality of life become available. The largest cohort study to date found that, not only was the average duration of illness more than a year, but, for a subpopulation of molluscum patients, especially those with larger numbers of lesions and those with higher CDLQI scores, the impact on quality of life was significant.4

Despite identification of molluscum nearly two centuries ago,3 as of this writing, there are no treatments approved by the U.S. Food and Drug Administration (FDA),1 nor is there consensus on the optimal treatment paradigm. While several excellent reviews of treatment options for molluscum have been published recently,6-9 clinical guidance remains limited in the United States. The goal of this review was to collect and summarize both evidence- and experience-based information about treatments and considerations for special clinical presentations.

To this end, a group of pediatric and adult dermatologists widely recognized for their expertise in treating molluscum contagiosum convened to collectively discuss their treatment approaches. In Part I, the group identified seven therapies used frequently today and provided insights gained from their decades of experiences. In Part II, the group identified and discussed the key considerations for five clinical presentations frequently encountered when treating patients with molluscum.