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Molluscum contagiosum - Management
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What self-care advice should I give someone with molluscum contagiosum?
- Reassure people that molluscum contagiosum is a self-limiting condition. Spontaneous resolution usually occurs within 18 months.
- Explain that lesions are contagious, and it is sensible to avoid sharing towels, clothing, and baths with uninfected people (e.g. siblings).
- Encourage people not to scratch the lesions. If it is problematic, consider treatment to alleviate the itch.
- Exclusion from school, gym, or swimming is not necessary.
Basis for recommendation
These recommendations are based on expert opinion from a review article [Smolinski and Yan, 2005] and guidelines from the Health Protection Agency (HPA) on The management of communicable diseases in schools, nurseries & other childcare settings [HPA, 2007].
- The mean duration of each lesion is 8 months [Tyring, 2003] and once cleared completely, recurrence is rare [Ginsburg, 1986].
- There is no trial evidence to support the recommendations to limit the spread of infection.
How should I treat molluscum contagiosum?
- Treatment is not usually recommended. If lesions are troublesome or considered unsightly, use simple trauma or cryotherapy, depending on the parents' wishes and the child's age:
- Squeezing (with fingernails) or piercing (orange stick) lesions may be tried, following a bath. Treatment should be limited to a few lesions at one time.
- Cryotherapy may be used in older children or adults, if the healthcare professional is experienced in the procedure.
- Eczema or inflammation can develop around lesions prior to resolution. Treatment may be required if:
- Itching is problematic; prescribe an emollient and a mild topical corticosteroid (e.g. hydrocortisone 1%).
- The skin looks infected (e.g. oedema, crusting); prescribe a topical antibiotic (e.g. fusidic acid 2%).
- For more information see Treatment of flares and Treatment of infected eczema in the CKS topic on Eczema - atopic.
Additional information
- Squeezing or piercing: wear gloves and discard the curd-like material inside. Lesions take 1–2 weeks to improve.
- Cryotherapy with liquid nitrogen should be applied once, for 5–10 seconds, directly on the lesion. The aim is to achieve a halo of ice over the lesion and 1–2 mm of the surrounding skin. Repeat every 2–3 weeks until the lesion has gone. Consider using a topical anaesthetic (such as lidocaine/prilocaine cream) 1 hour before treatment, especially if a cluster of lesions is being treated.
Basis for recommendation
These recommendations are based on pragmatism and expert opinion from review articles [Guirguis-Blake, 2006; Lio, 2007; Nelson and Morrell, 2007]:
- Most people do not require treatment, as lesions will usually resolve within 1–2 years, and do not limit activities or cause symptoms.
- No treatments are licensed in the UK for treating molluscum contagiosum [BASHH, 2008].
- CKS did not identify any randomized controlled trials comparing treatments with watchful waiting. A Cochrane review concluded there was insufficient evidence to determine whether treatments are effective [van der Wouden et al, 2006]. In addition, there is no evidence that treatment prevents spread of infection, and the approaches used can be painful and lead to scarring.
- Eczematous reactions are common, especially in children with atopy [Hanna et al, 2006; Lio, 2007]. Leaving eczema untreated could result in further scratching, spread of the virus, and persistence of the infection [Sladden and Johnston, 2004].
How should I treat anogenital molluscum contagiosum?
- Treat anogenital lesions in the same way as elsewhere on the body. In addition, for adults:
- Advise the use of condoms, although transmission may still occur by skin-to-skin contact.
- Refer to genito-urinary medicine for screening for other sexually transmitted infections.
Basis for recommendation
This recommendation is based on the United Kingdom national guideline on the management of molluscum contagiosum (2007) from the British Association of Sexual Health and HIV [BASHH, 2008].
- A retrospective case note review of people attending a genito-urinary medicine clinic for molluscum contagiosum showed concurrent sexually transmitted infections in 23.2% of men and 10.5% of women [Fitzgerald et al, 2002].
- Condoms will offer partial protection. The molluscum virus does not need mucous membranes for transmission, and will spread by skin contact [Tyring, 2003].
When should I refer a person with molluscum contagiosum?
- For people who are HIV-positive with extensive lesions, refer urgently to a HIV specialist.
- For people with eyelid-margin or ocular lesions and associated red eye, refer urgently to an ophthalmologist.
- Refer adults with anogenital lesions to genito-urinary medicine, for screening for other sexually transmitted infections. In children, lesions are commonly seen in anogenital areas, but referral for suspected sexual abuse should only be arranged if there is other evidence to suggest this.
- Consider referring to a dermatologist if:
- There is diagnostic uncertainty.
- The person is known to be immunocompromised.
- Lesions are extensive and painful (although inflamed lesions may indicate resolution).
Additional information
- The following treatments may be considered by a specialist:
- Surgical (e.g. curettage, cautery).
- Topical (e.g. pulsed dye laser, phenol ablation, imiquimod 5%, cantharidin, potassium hydroxide 10%, podophyllin, silver nitrate paste, benzoyl peroxide 10%, and retinoids).
Basis for recommendation
These recommendations are based on expert opinion [NHS Scotland, 2005; BASHH, 2008] and what CKS considers to be good clinical practice in the UK.
- A specialist may offer diagnostic investigations (e.g. skin biopsy) [Smolinski and Yan, 2005] and provide treatments not available in primary care. The evidence for curettage, phenol ablation, imiquimod, potassium hydroxide 10%, podophyllin, and cantharidin treatments is limited to small uncontrolled trials.
- Rarely, eyelid or ocular molluscum contagiosum can cause keratoconjunctivitis, which needs an urgent referral [Redmond, 2004].
- Molluscum contagiosum in people with immunosuppression can be progressive and resistant to treatment [Gottlieb and Myskowski, 1994]. Extensive lesions in a person with HIV may indicate a falling CD4 count, which needs attention [Schwartz and Myskowski, 1992].
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