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Molluscum contagiosum: Diagnosis and treatment


Treatment might not be needed

If your child has a healthy immune system, the molluscum bumps will eventually clear on their own, so your dermatologist may not recommend treatment.

If you or your child could have molluscum contagiosum, seeing a dermatologist has benefits. First, you’ll find out whether it’s molluscum or something else. To the untrained eye, many skin conditions can look like molluscum.

If you have molluscum, your dermatologist can tell you whether treatment is recommended.

Here’s what you can expect when you see a board-certified dermatologist.

How do dermatologists diagnose molluscum contagiosum?

A board-certified dermatologist can often diagnose this condition by looking at the bumps on your skin.

If there’s any doubt, your dermatologist will scrape off a bit of the infected skin so that it can be examined under a microscope. Your dermatologist can quickly and easily scrape off what’s needed during your office visit.

When do dermatologists recommend treating molluscum contagiosum?

Your dermatologist may recommend letting this disease clear on its own rather than treating it. When you have a healthy immune system, the body will get rid of the virus.

Once this happens, the skin will clear.

Clearing can take time. For many children, the body clears the infection within 6 to 9 months. Sometimes, it takes longer. Some patients continue to get bumps on their skin for 3 to 4 years. There have been reports of it taking 5 years for the bumps to go away completely.

Treatment may be recommended for patients who have:

  • A chronic skin condition, such as eczema

  • Molluscum in the genital area

  • A weakened immune system and numerous bumps

  • Extremely bothersome molluscum

Antiretroviral treatment can clear molluscum in HIV-positive patients: If someone is HIV-positive, the bumps can grow large and cover large areas of skin. Starting antiretroviral therapy (ART) can help clear the skin. It is considered the treatment of choice for anyone who is HIV-positive and has molluscum.

How do dermatologists treat molluscum contagiosum?

Several treatment options are available. It’s important to know that there is no one best treatment for molluscum.

Dermatologists choose treatment based on many considerations, such as a patient’s overall health, number of molluscum bumps, and where the bumps appear. For children, age is also an important consideration.

Your dermatologist may recommend treatment that you:

  • Receive in your dermatologist’s office

  • Apply at home

  • Take for a prescribed amount of time

No matter which treatment is used, treatment takes time. The following explains the different treatments and what each involves.

Treatment you receive in a dermatologist’s office: The goal of this treatment is to destroy the bumps without harming the skin. To do this your dermatologist may use:

Cantharidin (beetle juice): Made from blister beetles, dermatologists have used this to treat warts and molluscum since the 1950s. When treating molluscum bumps, your dermatologist applies the beetle juice to each bump. Your dermatologist will apply it to each bump in such a way that a water blister forms.

You should see a blister on each treated bump within 24 to 48 hours. As the skin heals, the bumps clear. This usually occurs within 2 weeks.

To be effective, most patients need 2 in-office treatments.

Wash off cantharidin after treatment

When your dermatologist uses cantharidin (beetle juice) to treat molluscum, you need to wash it off at home with soap and water to prevent a serious skin irritation.

When applied by a dermatologist, this is a safe and effective treatment for molluscum. It’s often a treatment for young children because it is painless when applied.

Warning

Cantharidin should only be applied in a doctor’s office. When you buy this treatment online and apply it at home, you risk serious side effects, such as deep chemical burns, intense pain, and scarring.

Cryotherapy: Your dermatologist applies an extremely cold substance to each molluscum bump. This extreme cold can effectively destroy the bumps. Because new molluscum can form, you will need to return for treatment every 2 to 3 weeks until the bumps clear.

Cryotherapy can be painful, so it’s not recommended for young children. Due to the pain, it’s seldom used to treat patients who have many molluscum bumps.

Cryotherapy may be a treatment option for a teen or adult wrestler who needs to get back to the sport.

Curettage: During this treatment, your dermatologist uses a medical device called a curette to remove the molluscum bumps from the skin. In skilled hands, this is a simple and effective treatment that causes little or no bleeding.

Because your dermatologist cuts into the skin, this treatment can be frightening for young children. As such, curettage is usually only performed on older children, teens, and adults.

Pulsed dye laser (PDL): This may be a treatment option for someone who has many molluscum bumps. It’s also recommended for patients with difficult-to-treat molluscum, such as people with AIDS.

Studies show that PDL can effectively treat dozens of bumps in less than 2 minutes. During one such study, 43 patients who had many molluscum bumps were treated with the PDL. In 42 of these patients, all the bumps cleared within one month of PDL treatment.

The treated skin tends to heal completely between 1 and 2 weeks on the face. When treating other areas of the body, the skin tends to heal completely between 2 and 4 weeks.

If you are considering PDL, it’s important to know the following:

  • Insurance rarely covers the cost of this treatment, which tends to be expensive.

  • PDL has been safely and effectively used on children as young as 8 years old, but it may be difficult to treat younger children with PDL.

  • People who have skin of color can develop temporary (lasting 6 weeks to 6 months) lighter or darker spots on the skin treated with the PDL.

  • Not every dermatology office offers PDL, so you may be referred to another dermatologist for treatment.

Use forceps or a scalpel to remove the core: During this procedure, your dermatologist squeezes each molluscum bump to remove the cheesy substance inside, which contains the virus. This can be painful, so medication is applied to numb the skin first.

You should not try this at home. Without proper technique, you can cause a serious infection and spread the virus to other parts of your body.

Other treatments that your dermatologist may use: Other treatments that should be applied in a dermatologist’s office, include:

  • Bichloracetic acid

  • Glycolic acid

  • Lactic acid

  • Trichloroacetic acid peel

Placing any of the above on the bumps helps to destroy them. You may need several visits for this to be effective. These treatments tend to burn when applied. Afterward, you may have some redness, pain, or swelling. Some patients develop mild scars.

Treatment you apply at home: Sometimes, molluscum is best treated with a medication that you apply at home. While you will find many treatments sold online, these are the ones that a dermatologist may recommend.

Warning

Some molluscum treatments that you can buy online without a prescription may not work and could be harmful, according to the Centers for Disease Control and Prevention (CDC).

Imiquimod cream: This medication helps stimulate the body’s immune system so that it will clear the bumps. You apply the cream as directed to the bumps, usually 2 or 3 times a week. After the cream sits on the bumps for a prescribed amount of time, you must wash it off.

You must continue to apply imiquimod until the bumps clear, which is usually about 16 weeks.

It’s important to know that no one treatment works for everyone. Signs that imiquimod is working include swelling and irritated skin.

The CDC does not recommend imiquimod for young children.

Prescription required: Yes

Podophyllotoxin cream: This cream can be an effective treatment for some sexually active patients. You apply the cream to each molluscum bump, usually twice a day for 3 weeks.

This is not an option for pregnant women. Applying it to the genital area can harm the baby.

Prescription required: Yes

Salicylic acid: Often used to treat warts, this can be effective for molluscum as well. Your dermatologist can tell you how often to apply it. The goal is to continue using it until you get a reaction.

Prescription required: No

Sinecatechin (green tea): This botanical, which is made from green tea, has been approved by the FDA to treat genital and anal warts. It’s reported that this may also effectively treat molluscum bumps in the genital and anal areas.

Prescription required: Yes

Tretinoin: To get results, you must apply this correctly. Your dermatologist can show you how to apply it by using a toothpick to get the reaction you need. The goal is to irritate the surface of the skin, which can help the body’s immune system clear the virus.

Prescription needed: Yes

Medication you take at home

Cimetidine: This medication is used to treat ulcers and conditions that cause the stomach to produce too much acid, such as heartburn.

It may also be a treatment option for a patient who has severe eczema (atopic dermatitis) and molluscum that covers most of the body. Dermatologists recommend it only when other treatment fails to work.

Prescription needed: No

What is the outcome for someone who has molluscum?

For most people the skin will clear without treatment, usually within 18 months. A few people continue to have bumps for longer.

Treating molluscum may clear the skin more quickly; however, the bumps can return after treatment. It’s also possible to pick up the virus again, which can cause new bumps.

Following the self-care that dermatologists recommend can help prevent new bumps. You’ll find these recommendations at, Molluscum contagiosum: Self-care.


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References
Brunk D. “Managing molluscum contagiosum: The great imitator.” Pediatr News. December 3, 2014.

Centers for Disease Control and Prevention (CDC). “Molluscum contagiosum: Risk factors.” Page last reviewed May 2015. Page last accessed March 22, 2019.

Coloe J. “P3004: Evaluation of the efficacy and safety of cantharidin 0.7% in the treatment of pediatric molluscum contagiosum.” J Am Acad Dermatol. 2009;60(3): Suppl. 1, Page AB143. No financial disclosure identified.

Dohil MA, Lin P, et al. “The epidemiology of molluscum contagiosum in children.” J Am Acad Dermatol. 2006;54(1):47-54.

Guzman AK, Schairer DO, et al. “Safety and efficacy of topical cantharidin for the treatment of pediatric molluscum contagiosum: a prospective, randomized, double-blind, placebo-controlled pilot trial.” Int J Dermatol. 2018;57(8):1001-6.

Jahnke MN, Hwang S, et al. “Cantharidin for treatment of facial molluscum contagiosum: A retrospective review.” J Am Acad Dermatol. 2018;78(1):198-200.

Leung AKC, Barankin B, et al. “Molluscum contagiosum: An update.” Recent Pat Inflamm Allergy Drug Discov. 2017;11(1):22-31.

Pavlovic M. “Treatment of facial molluscum contagiosum with trichloroacetic acid.” Pediatr Dermatol. 2009 Jul-Aug; 26(4):425-6.

Schaffer JV, Berger EM. “Molluscum contagiosum.” JAMA Dermatology Patient Page. September 2016. Last accessed March 25, 2019.

Skinner RB, Jr. “Treatment of molluscum contagiosum with imiquimod 5% cream.” J Am Acad Dermatol 2002;47:S221-4.

Tom W, Fallon Friedlander S. “Poxvirus infections.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1911-13.

van der Wouden JC, van der Sande R, et al. “Cochrane Review: Interventions for cutaneous molluscum contagiosum.” Cochrane Database Syst Rev. 2017;5:CD004767.

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