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Treatment of Molluscum Contagiosum in Adult, Pediatric,

and Immunodeficient Populations
Harrison P. Nguyen, Eric Franz, Kelly R. Stiegel, Sylvia Hsu, and Stephen K. Tyring

Background: Molluscum contagiosum is a viral infection of the skin that is widely considered to be a self-resolving disease that
can be treated with benign neglect. However, the clinical reality is that the disease can vary widely by anatomic site and by
recalcitrance to treatment and remains a significant cause of morbidity worldwide.
Objective: The purpose of this review was to compile an updated resource for clinicians that addresses the management of the
broad spectrum of molluscum cases that may be encountered.
Methods: A comprehensive PubMed search was performed to identify publications on the treatment of molluscum infection,
including presentations that may be rare or difficult.
Results: The specific clinical scenario of molluscum must be considered when selecting the optimal therapy because certain
treatments can be more effective for specific patient subpopulations.
Conclusion: Further attention must be directed toward standardizing treatment for molluscum infection based on patient age
and immune status.

Contexte: Le molluscum contagiosum est une infection virale de la peau, qui est souvent considérée comme une maladie
spontanément résolutive et dont le traitement nécessite peu d’attention. Toutefois, la pratique clinique révèle que l’intensité de la
maladie varie beaucoup selon le siège touché et selon le degré de résistance au traitement, ce qui en fait une cause importante de
morbidité dans le monde.
Objectif: L’examen de la documentation avait pour but de constituer une ressource à jour à l’intention des cliniciens, portant sur
la prise en charge du large éventail de cas de molluscum, susceptibles d’être vus en pratique.
Méthode: Nous avons procédé à une recherche exhaustive de publications, dans la base de données PubMed, sur le traitement
du molluscum, y compris sur les tableaux cliniques rares ou difficiles à identifier.
Résultats: Le contexte clinique particulier du molluscum doit être pris en considération lorsque vient le temps de choisir le
traitement optimal étant donné que certains traitements sont plus efficaces que d’autres dans certains sous-groupes de patients.
Conclusion: Il faudrait redoubler les efforts afin de normaliser le traitement du molluscum selon l’âge et l’état du système

OLLUSCUM CONTAGIOSUM is a cutaneous and acid (DNA) virus from the Poxviridae family. The MCV
M mucocutaneous viral infection that is commonly
observed in school-aged children, sexually active adoles-
genome is covalently linked at both ends and encodes
several gene products that are involved in both viral life
cents, and immunocompromised individuals of all ages. cycle and host immune evasion.1–3 In otherwise healthy
The infection is caused by the molluscum contagiosum patients, MCV infection presents as a small cluster (11–20)
virus (MCV), a large double-stranded deoxyribonucleic of skin-colored papules that are 3 to 5 mm in diameter.4
Molluscum papules are clinically differentiated from
lesions formed by other cutaneous diseases by the presence
From the Department of Dermatology, Baylor College of Medicine,
Houston, TX; Department of Dermatology, University of Texas Medical of a central umbilication. However, this defining feature
School, Houston, TX; and Wayne State University Medical School, may be difficult to empirically observe in a variety of
Detroit, MI. clinical scenarios and, instead, may bear an appearance
Address reprint requests to: Harrison P. Nguyen, BA, 1 Baylor Plaza, similar to an acneiform eruption. Generally, the papules
Houston, TX 77030; e-mail: Harrison.p.nguyen@gmail.com. are benign and asymptomatic, although erythema and
DOI 10.2310/7750.2013.13133 itchiness at the site of infection are reported in a subset of
# 2014 Canadian Dermatology Association patients.

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Nguyen et al

Molluscum is transmitted through skin-to-skin contact eventually able to mount a successful cell-mediated
with the infected site, through contaminated fomites— immune response and overcome the virus’s pathomechan-
such as bath towels and clothing—and through vertical isms. Quality of life is a factor to consider when deciding
transmission during labor. The virus can also be whether or not to treat a pediatric patient as he or she may
autoinoculated, spreading from the initial site of infection suffer chastisement from peers at school if the lesions are
to other sites on the body.5 In 30% of patients, acute visible. Not treating pediatric infections also carries the
eczema develops around the papules approximately a risk of the disease spreading to classmates, and this
month after onset of infection.6 Eczema is associated with consideration may favor the option of treatment over
an increased risk of autoinoculation because patients are benign neglect.
more likely to scratch the eczematous region, thereby Currently, there is no Food and Drug Administration
spreading the viral particles to other sites of the body. The (FDA)-approved therapy for molluscum contagiosum.
acute eczema usually subsides spontaneously with the There is not one widely accepted standard of care, which
eradication of the molluscum lesions. A further clinical is especially problematic for immunodeficient patients,
association between molluscum and eczema was elucidated who often suffer from severe, persistent molluscum.
by an Australian study, which found that 62% of children Molluscum infection in the immunodeficient population
with molluscum contagiosum reported a history of eczema can be steadfastly recalcitrant to conventional treatment
and thus concluded that preexisting eczema likely predis- and can become physically and psychologically debilitat-
poses children to the infection.5 ing, with hundreds of lesions developing on the body.
Papules can appear on all cutaneous and mucocuta- Unfortunately, little is known about the efficacy of various
neous sites of the body, including the genitalia, as well as therapies for the immunodeficient population. A plethora
the perianal, orbital, and oral mucosa. Molluscum of the of case reports—each describing successful treatment of
genitalia and perianal regions can be either autoinoculated various singular immunodeficient patients—have been
or sexually transmitted. Autoinoculation to the genitalia published, but to our knowledge, there is no readily
can usually be distinguished by identifying lesions on available resource for the compilation and comprehensive
multiple regions of the body; in contrast, most cases of consensus of these findings. Finally, although molluscum
sexually transmitted molluscum are localized exclusively to infection on the genitalia is commonly observed clini-
the genital area. In addition to infecting the genitalia, cally—usually as a result of autoinoculation of conven-
molluscum can occasionally spread to the oral mucosa— tional molluscum infection—genital lesions can be
potentially from the genitalia during oral sex—as well as to accompanied by additional issues and problems that the
the conjunctiva and cornea.7,8 The latter scenario may clinician must consider when treating these cases. For
result in chronic conjunctivitis, keratoconjunctivitis, or example, although conventional molluscum can be
superficial punctate keratitis, which complicates treatment managed with benign neglect, sexually transmitted mol-
of lesions in the orbital region. luscum is important to treat not only for the benefit of the
Although data are limited, several studies have estimated patient but also to prevent spread to sexual partners.
the worldwide prevalence of the infection to be 5.0 to Taken together, molluscum presents differently based on
7.5%.9–11 The prevalence is increased in immunocompro- the patient population and necessitates specific treatments
mised populations (5.0–18%) and has been reported to be for each of the myriad presentations. Here we review key
as high as 30% in patients with advanced acquired immune findings and insightful clinical observations that have been
deficiency syndrome (AIDS).10 published on the management of the gamut of molluscum
In healthy patients, cutaneous molluscum contagiosum contagiosum infections.
is a self-limiting disease that often spontaneously resolves
in 6 to 9 months, usually without scarring. Current
therapy for healthy individuals merely accelerates the Clinical Management
clearance process and can be associated with unwanted
Molluscum in Immunodeficient Patients
side effects, such as scarring, erythema, and discomfort. As
a result, although permutations of therapeutic strategy In healthy individuals, molluscum contagiosum is often a
may be implemented based on each patient’s unique case, self-limiting infection that generally clears completely
many clinicians simply choose to employ benign neglect within several months. On average, 11 to 20 papules
for the treatment of molluscum. However, benign neglect appear on the body during the course of infection but
is usually effective only in healthy individuals, who are spontaneously resolve within 2 months.4 However, in an

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Treatment of Molluscum Contagiosum

immunodeficient host, MCV can cause severe, persistent resolution of severe molluscum in 11 patients and 50%
infection with hundreds of lesions that tend to be reduction in 18 patients (of a total of 30 subjects) after
recalcitrant to treatment. Extensive infection is indicative intralesional injection of 1 megaunit of IFN-a weekly for
of an advanced immunodeficient state. 4 weeks.21 Since then, several articles have reported its
Treatments that lead to wound formation, such as efficacy in treating lesions in patients with other immuno-
curettage and cryotherapy, can be effective in immunode- deficiency disorders using various dose frequencies. After the
ficient patients with mild infection. However, overall, such incomplete success of the initial report, the next study in
strategies are not optimal in immunocompromised 1999 employed subcutaneous injections and increased dose
patients for two chief reasons. First, open wounds elevate frequency to 3 megaunits of IFN-a three times a week for 6
the risk of additional cutaneous infection, which com- months and then, afterwards, weekly injections for 3
monly include candidiasis, human papillomavirus– months.22 This treatment strategy successfully achieved
associated warts, and staphylococcal pyoderma.12 Second, 95% clearance of molluscum in two siblings suffering from
in severe cases, the infection may be so widespread on the putative combined immunodeficiency. A 9-year-old with
body that treating individual lesions may not be practical hyperimmunoglobulin E syndrome also underwent the same
without risking continual autoinoculation. Several thera- therapy schedule as the siblings. This resulted in complete
pies, most of which are immunomodulators, have been clearance of his recurring molluscum lesions, which were
described in the literature to be successful for treating previously unresponsive to phenol, trichloroacetic acid,
molluscum in immunodeficient patients. These treatments cryosurgery, and imiquimod therapy.23 Most recently,
include 5% imiquimod cream, interferon-a (IFN-a) pegylated IFN-a was shown to completely resolve dissemi-
injections, and cidofovir. nated giant molluscum after 16 months of treatment in a 31-
The most well-described therapeutic agent, topical year-old woman with idiopathic CD4+ lymphocytopenia.24
imiquimod, is available on the market as 5%, 3.75%, and However, the regimen could not be increased from 50 mg per
2.5% creams. It is thought to activate both innate and week subcutaneously because the patient’s total leukocyte
adaptive immunity through Toll-like receptor 7 (TLR7), count dropped to as low as 2,900/mL. In patients with low
which is involved in pathogen recognition and the release leukocyte levels, it may be prudent to conduct regular white
of several immunostimulatory cytokines.13–15 A study blood cell counts when administering IFN-a treatment so
published in 2000 found 5% imiquimod (applied three that the regimen can be adjusted accordingly.
times weekly for up to 16 weeks) to be effective in Cidofovir, a nucleotide analogue of deoxycytidine
completely eradicating lesions in four of four adults with monophosphate, has been popularly used to treat
advanced but stable human immunodeficiency virus type 1 cytomegalovirus (CMV) retinitis in AIDS patients.
(HIV-1) disease.16 Interestingly, subjects with HIV-1 had Readily available in the intravenous form, cidofovir
a better overall response to therapy than both their prevents viral transcription and replication by inhibiting
immunocompetent counterparts and the healthy children viral DNA polymerase.25 Not surprisingly, cidofovir is also
who participated in the study. Additionally, successful effective at inhibiting viral replication in a number of other
resolution using imiquimod three times per week has been DNA viruses, including MCV. This discovery was made
reported in a woman with Sjögren syndrome, a renal haphazardly by Meadows and colleagues when an HIV-
transplant patient with multiple giant molluscum, and positive man noticed dramatic clearing of his molluscum
several other HIV-positive patients with severe mollus- after being treated with intravenous cidofovir for treatment-
cum.4,17–19 Imiquimod therapy often results in nonspecific resistant CMV retinitis.26 The man’s molluscum was
inflammation and dermatitis, especially in skin folds or in previously unresponsive to cantharidin, cryotherapy, cur-
areas that have been traumatized due to scratching. Less ettage, IFN-a, and several other first-line treatments. In the
common side effects include headaches, back pain, muscle same study, another HIV-positive patient also with
aches, tiredness, flu-like symptoms, swollen lymph nodes, concurrent CMV retinitis and molluscum contagiosum on
diarrhea, and fungal infections.20 the face was successfully treated with intravenous cidofovir
IFN-a is a glycoprotein cytokine that is endogenously at a dosage of 5 mg/kg once a week for 2 weeks, followed by
produced in response to viral infection and produces several 5 mg/kg once every 2 weeks. This regimen was slightly
proteins that are involved in inhibiting viral replication. The higher than used for the first patient, whose lesions
recombinant form was initially used in dermatology mostly responded to a dosage of 2 mg/kg once weekly for 2 weeks
for the treatment of recalcitrant condyloma acuminata until and then a maintenance therapy of 2 mg/kg every 2 weeks.
a study, published over a decade ago, described the successful However, systemic cidofovir is known to be nephrotoxic, so

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Nguyen et al

topical cidofovir has been explored as a potential ther- the lesions have also been successfully resolved with the
apeutic agent for immunodeficient patients but has thus far topical agent 0.7% cantharidin.27 Although cantharidin is
yielded promising but inconclusive results. A third HIV- used by many physicians in the United States as an off-
positive patient in the Meadows and colleagues study label treatment for molluscum, the compound is not
achieved successful resolution of recalcitrant molluscum currently approved by the FDA and therefore is often
infection on his face using 3% cidofovir cream daily for acquired from Canada.29
5 days a week. The lesions, which originally covered 95% of Noncongenital molluscum infections in children are
his face, were completely cleared within 1 month without responsible for myriad pediatrician and dermatologist visits
any sequelae. Moderate inflammation appeared during the each year. A common treatment used for these infections is
second week of therapy but spontaneously resolved 2 weeks topical cantharidin. Although topical cantharidin is often
later. Similarly, complete resolution of a severe case of used to treat pediatric molluscum infections, its potency
molluscum on the face of another HIV patient was recently might not be as evident in this patient population as
achieved in one author’s investigational center after 2 originally believed. A double-blind randomized clinical trial
months of topical cidofovir compounded into a 2% evaluated the treatment of 29 children ages 5 to 10 years
ointment (unpublished report). Currently, the topical form with topical cantharidin. The performance of cantharidin
is not readily available on the market and must be was observed to be similar to that of the placebo. However,
compounded as a 1 to 3% cream (Dermovan, Galderma the authors conceded that their definition of ‘‘clearance’’
Laboratory, Fort Worth, TX). may have been stricter than similar trials, which may have
impacted the results.30 Regardless of this study’s findings, a
survey of 95 clinicians indicated a 92% satisfaction rate with
Molluscum in Pediatric Patients
cantharidin’s efficacy in treating molluscum, possibly
Viral infections, such as the human papillomavirus and indicating a disparity between objective and subjective
HIV, can be vertically transmitted from mother to infant satisfaction with the therapy.31
if proper measures are not taken. Although only a Additional therapies for pediatric molluscum include
handful of congenital cases are reported in the literature, topical imiquimod, curettage, cryotherapy, retinoids,
it is believed that MCV can be transmissible during labor cimetidine, salicylic acid, duct tape, Candida antigen,
as well. Given that MCV has an estimated incubation potassium hydroxide (KOH), and cidofovir.32 Hanna and
period of 14 days to 6 months, molluscum lesions may colleagues conducted a randomized controlled trial
not be visible on the infant at birth and thus could comparing the efficacies of curettage, cantharidin, imiqui-
explain the dearth of cases reported in the literature.27 mod, and a combination of salicylic acid and lactic acid.33
This observation has led to the hypothesis that most The study included 124 pediatric patients equally sorted
infantile patients presenting with molluscum likely into four groups. For the curettage group, 80.6% required
contracted the infection through vertical transmission.27 only one visit, 16.1% required two visits, and 3.2%
A literature review yielded seven reported cases of required three visits for treatment of their molluscum.
congenital molluscum. Interestingly, in nearly all Comparatively, the percentages were 36.7%, 43.3%, and
reported cases, molluscum lesions appeared in a halo- 20.0% for cantharidin; 55.2%, 41.4%, and 3.4% for
like ring around the scalp, which is likely associated with imiquimod; and 53.6%, 46.4%, and 0% for salicylic and
the increased cervical pressure placed on this region of glycolic acid. Thus, curettage was reported as the most
the scalp during labor and delivery.27 Additionally, potent treatment, along with having the lowest incidence
several of the infants also presented with molluscum of side effects.
lesions on other sites of the body. One 2012 case report Imiquimod 5% cream has received attention as a
identified a linear track of molluscum lesions in the pragmatic treatment option for pediatric molluscum
coccygeal region with additional lesions presenting on infection because the cream can be applied at home,
the back and upper arm in a 1-year-old infant.28 It is decreasing the burden of parental responsibility of follow-
possible to confirm the mode of transmission through up visits. In a study comparing the effects of imiquimod
viral genotyping, but to date, no studies have examined 5% cream versus cryotherapy for molluscum contagiosum,
the genotype of congenital molluscum lesions. As in the cryotherapy was performed with liquid nitrogen for two
case of sexually transmitted molluscum, the main therapy 10- to 20-second cycles on a group of 37 patients at an initial
for congenital molluscum lesions is direct destructive visit and 1 week later if needed, whereas the other group of
measures with curettage or cryotherapy. Alternatively, 37 patients received imiquimod cream five times weekly for

302 Canadian Dermatology Association | Journal of Cutaneous Medicine and Surgery, Vol 18, No 5 (September/October), 2014: pp 299–306
Treatment of Molluscum Contagiosum

up to 16 weeks. Although the investigators observed a more Although these results seem promising, cimetidine may be
rapid clearance of the infection in the cryotherapy group at effective only in atopic patients.39
6 weeks, there was no statistical difference between the two
groups after a 12-week period, with both groups demon-
Molluscum in Adults
strating approximately 100% clearance. At a follow-up
conducted 6 months after the study, the imiquimod group Molluscum infections are most common in children ages 1
exhibited a superior cosmetic outcome, with only 2 patients to 10, but adult infections also occur.40 Sexually active
displaying residual hypopigmentation, versus 15 patients patients are more susceptible to molluscum infections in
with pigmentary changes and 8 patients with scarring or specific anatomic regions, mainly the genital area.
atrophy in the cryotherapy group. There were no cases of Molluscum contagiosum commonly infects the genitalia
relapse in the imiquimod group, although there were 3 either through autoinoculation of conventional mollus-
patients in the cryotherapy group whose infections cum from other sites of the body or through sexual
relapsed at 6 months.34 An additional study conducted transmission of the genital lesions on another individual.
in India evaluated the safety and efficacy of imiquimod Regardless of the infection source, genital infection must
5% cream versus 10% KOH solution, applied 3 days per be attentively managed.
week, in patients between the ages of 1 and 40. The mean A recently published 20-year longitudinal study
lesion count decreased from 22.39 to 10.75 in the indicated that although the rates of other sexually
imiquimod group (18 patients) and from 20.79 to 4.31 transmitted infections (STIs) in the authors’ community
in the KOH group (19 patients) at the end of 12 weeks. hospital have remained relatively stable over the past two
Complete clearance of the infection was observed in 8 decades, there has been a threefold increase in the number
(44%) of the imiquimod patients and 8 (42.1%) of the of cases of molluscum infection in the genital and perianal
KOH patients. The researchers concluded that both regions.41 A subsequent study found molluscum to be the
topical methods were effective in treating molluscum, second most prevalent nonulcerative STI after genital
although KOH had a faster onset of action but was also warts. This relative increase is thought to be a result of the
associated with a greater incidence of side effects.35 A persistent and recurrent nature of viral infections.42 One
Turkish study examined the application of 10% KOH Dutch study reported that sexually transmitted molluscum
aqueous solution in 40 pediatric patients with molluscum. infections accounted for 1 to 3% of all reported cases of
Parents were instructed to apply the solution twice a day STIs and estimated the worldwide prevalence of sexually
to all lesions and continue until the lesions showed signs transmitted molluscum to be between 2 and 8% of the
of inflammation or superficial ulceration. Complete total population. The disease is most prevalent in the 20-
clearance was achieved in 37 (92.5%) patients after a to 30-year-old age group and affects men and women
mean period of 4 weeks. Local side effects were equally. There is an increased incidence of disease in
experienced by 12 children (32.4%), but it was concluded heterosexual populations compared to homo- and bisexual
that KOH was a safe, effective, and inexpensive treatment populations.41–43 Additionally, there is an increased
for molluscum in children.36 prevalence of sexually transmitted molluscum in married
A study published in 2011 indicated that immunother- patients.
apy in the form of intralesional Candida antigen injection Sexually transmitted molluscum is diagnosed primarily
may serve as a promising treatment for pediatric through an evaluation of patient history and physical
molluscum infections. The study participants were admi- examination, noting the localization of the molluscum
nistered no more than 0.3 mL of Candida antigen lesions to the genital and perianal regions. Although single
intralesionally at 4-week intervals until clearance of the lesions may occur, sexually transmitted molluscum lesions
infection was achieved. The treatment effected complete are typically found in clusters of 30 papules or fewer in
clearance in 55.2% of the 29 pediatric patients and partial otherwise healthy individuals.43 Molluscum can be identi-
clearance in 37.9%, with a treatment total response of fied by its characteristic central umbilication, but in cases
93%. The only reported side effects were pain and where the clinical picture is not clear, laboratory testing
discomfort at the time of injection.37 may be used to confirm the diagnosis.42 Patients testing
A final potential oral therapy for pediatric molluscum positive for genital molluscum infection should be tested
is the H2-receptor antagonist cimetidine. When adminis- for other concurrent STIs as a precautionary measure.43
tered to 13 children at a dose of 40 mg/kg/d, complete Although the efficacy of therapeutic interventions con-
clearance of the lesions was seen in 10 of the patients.38 tinues to be debated in conventional, non–sexually

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Nguyen et al

transmitted cases of molluscum, active treatment in common side effects of imiquimod treatment were
sexually transmitted cases is unequivocally indicated.41 erythema, erosion, and pruritus.43
This course of action is favored to reduce the risk of As previously mentioned, molluscum can occasionally
further sexual transmission, to prevent additional auto- spread to the oral mucosa. Although it is most commonly
inoculation, and to improve a patient’s quality of life.43 An observed in epidermal tissues, a review of the literature
Indian study notes that evidence is accumulating that STIs, found six reported cases of molluscum infections of the
including molluscum, augment HIV infectiousness and oral cavity in immunocompetent individuals. These cases
promote its transmission.42 This further demonstrates the presented as single or multiple papules with the character-
need for prompt management of sexually transmitted istic central umbilication, although case reports note a
molluscum contagiosum. great deal of variance in the appearance of intraoral
The standard treatment for molluscum lesions is molluscum lesions.48–51 Intraoral molluscum papules have
generally the same as the treatment for the genital warts been described as skin colored, yellowish white, and waxy.
caused by the human papillomavirus. Physical ablation of In one case, a smooth nodule 2.5 cm in diameter initially
the infected tissue via curettage, electrocautery, or suspected to be squamous cell carcinoma was found to be
cryotherapy is considered to be first-line therapy in the a molluscum lesion on histologic analysis.51 Intraoral
treatment of sexually transmitted molluscum.43 One study molluscum lesions are typically localized to the labial and
reported clearance of infection in 92.3% of patients after buccal muscosa as well as the hard palate. Mild erythema is
15 days of ablative treatment.41 However, as noted above, often observed surrounding the papule clusters.48–51
in patients concurrently infected with molluscum con- Multiple studies have reported complete clearance of
tagiosum and HIV, destructive therapies may not be molluscum lesions with minimal scarring within 2 weeks
effective. Instead, other treatment strategies should be of curettage or excisional biopsy.48–51 In one of these
developed, particularly in cases of giant, recalcitrant, or studies, no additional or recurring lesions were found
extensive molluscum infection that are often seen in during a follow-up examination 2 years later.48
immunocompromised patients.44 Physicians may alterna- Ocular and periocular molluscum infections can occur
tively use chemical ablation such as trichloroacetic acid or in pediatric, adult, and immunosuppressed patients.
podophyllin to destroy infected tissue. However, because Molluscum lesions in these regions can be difficult to
of the low efficacy and high toxicity of these treatments, identify or are unusual in appearance. One retrospective
they are not commonly used.43 study of several histologically proven cases of molluscum
In addition to physician-administered physical and contagiosum found that molluscum was not diagnosed
chemical ablation, there are a number of treatment during the initial visit in up to 40% of the cases.52 As in
options that may be self-administered by the patient. most cases of molluscum infection, diagnosis of ocular or
Podofilox, which is the active ingredient in podophyllin, periocular molluscum is made based on the presence of the
and retinoic acid have been shown to have varying characteristic molluscum lesions in the eye and orbital
success in treating cutaneous warts and may be effective regions with or without additional lesions on the face or
in treating molluscum lesions.43,45 The most common body. Rarely, molluscum lesions may be found in the
side effects noted in these self-administered ablative conjunctiva or epibulbar region of the cornea. Chronic
treatments are xerosis, burning, irritation, itching, conjunctivitis or keratoconjunctivitis secondary to mol-
inflammation, and erosion.43 Self-administered topical luscum infection has been associated with both ocular and
treatments that modulate the local immune response periocular molluscum lesions. In most cases, patients
have been used in the treatment of genital molluscum present with chronic conjunctivitis as their primary
lesions. In clinical trials, treatment with 5% imiquimod complaint, and a diagnosis of molluscum contagiosum is
5 days a week for 4 to 16 weeks led to complete clearance made on physical examination.52,53 However, the con-
in 80% of study patients and a 50% reduction in junctivitis is believed to be secondary to molluscum
molluscum lesions in the remaining 20%, with very low infection and is hypothesized to result from either a host
recurrence rates at 32 weeks posttreatment.46 An addi- hypersensitivity reaction to MCV proteins or toxic damage
tional double-blind study found that three times daily mediated by MCV.52 The most common treatment for
application of 1% imiquimod for 4 weeks resulted in a ocular and periocular molluscum infections is surgical
clearance rate of 86%.47 In our clinic, we frequently use excision of the lesions, which has generally led to rapid and
3.75% imiquimod cream as well as sinecatechin ointment dramatic resolution of the disease.52–54 The concurrent
to treat genital molluscum (data forthcoming). The most conjunctivitis has been frequently observed to resolve

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Treatment of Molluscum Contagiosum

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