Molluscum contagiosum (MC) treatment can be a point of contention for parents of children with the viral skin condition and their physicians. Parents are often insistent on treatment, fearing secondary infection, transmission to other family members, scarring from lesions, or simply the embarrassment that can result from having as many as hundreds of round, fleshy bumps on the skin. Doctors, on the other hand, may be hesitant to treat, trusting the virus will eventually run its course. Some are uncomfortable treating the condition due to a lack of experience or a dissatisfaction with existing treatments, including cryotherapy, curettage, and blistering agents such as cantharidin, which may eliminate the lesions but does not treat lesions that may not yet be apparent.
“Regarding those pesky molluscum bodies, there are many off-label therapies that are currently being used,” said Stephen W. Stripling, MD, a practicing pediatrician in the Charleston, SC, area and one of seven practitioners interviewed recently concerning MC treatment and prescribing habits. “With so many options, no single one has risen to the top as being a best therapy or drug of choice. Therapy needs to be individualized, and in a self-resolving condition like molluscum contagiosum, sometimes the best ‘medicine’ is to simply observe and wait it out.”
Treatment Differences Among Specialties
Treatment choices – including whether to treat – vary widely among practitioners and specialties, with dermatologists being more likely than pediatricians to administer treatment, according to the interviews.
Annette Murphy, a dermatology physician assistant at Associates in Dermatology in Orlando, FL, for example, said she has treated nearly all of her patients with MC she has seen, while Dr Stripling believes the best treatment is no treatment at all. Most practitioners, however, fall somewhere in between, the interviews revealed.
Amy Paller, MD, professor and chair of dermatology at Northwestern University Feinberg School of Medicine and a pediatric dermatologist at the Lurie Children’s Hospital of Chicago (IL), said she ends up treating about 80% of her patients with MC and often sees children whose parents are frustrated by the ineffective topical treatments or lack of treatment offered by pediatricians. Diana Stafford, MD, a board-certified pediatrician in private practice in San Diego, CA, said she treats about 40%.
When pediatricians treat MC, they are more likely to choose conservative treatment, using topical preparations such as salicylic acid, tretinoin, or imiquimod. In contrast, dermatologists tend to take a more aggressive approach, the experts acknowledged.
“The pediatricians probably never do cryotherapy or curettage,” said Rebecca Baxt, MD, a board-certified dermatologist and owner of BAXT CosMedical in Paramus, NJ, and clinical assistant professor at New York University School of Medicine. “In my experience and opinion, [pediatricians] usually either tell the patients or the parents to leave it alone, [that] it’s going to go away on its own, or they give them the salicylic acid or maybe the imiquimod, although imiquimod doesn’t work all that well.”
Dermatologists, on the other hand, are more likely to use cantharidin or curettage, said David S. Reitman, MD, associate professor of pediatrics and attending adolescent medicine physician at MedStar Georgetown University Hospital in Washington, DC.
“If I am going to use a low pH blistering agent, also known as a vesicant,” adds Dr Stripling, “I make sure that the family is well-informed and document in the chart about risks. I have had more than one family return after treatment from me or a local dermatologist with frustration and anger about painful blisters, albeit temporary to their child.”
Other Factors in Choosing Treatment
In some cases, treatment choice depends on factors such as the number and location of the lesions and the age and skin color of the patient. For example, Murphy said she would consider curettage for a few lesions and if those lesions are “on the back and the parents really want to do it.” For the face, however, she would choose a treatment less likely to cause scarring such as tretinoin or imiquimod. Because cryotherapy can leave a nonpigmented scar, Murphy will not use it on someone who is darkly pigmented.