Molluscum contagiosum - Treating molluscum contagiosum

Treatment for molluscum contagiosum (MC) is not routinely recommended because most cases clear up in around 6 to 18 months without the need for treatment.

If left alone, MC doesn't tend to result in scarring or cause any symptoms other than spots.

Many of the treatments available for MC can be painful and may be upsetting for young children, and some may increase the chances of permanent scarring.

Treatment is usually only recommended for adults and older children who have spots that are particularly unsightly and are affecting their quality of life.

Treatment is also recommended for people with weakened immune systems, as the condition can take several years to clear in these cases. 

Topical treatments

There are a number of topical treatments (creams, lotions and ointments) that can be used to treat MC, although there's not enough evidence to know if any particular treatment is more effective than the others.

Potassium hydroxide

Potassium hydroxide is a medication available in liquid form that can improve MC by breaking down the skin cells infected by the virus, allowing the immune system to tackle it.

The liquid is applied twice a day on each spot. The spots should eventually become inflamed, before healing and disappearing within the next few weeks.

You should stop using the medication once the spots have started to become inflamed, or after 14 days if the medication doesn't seem to be working.

Side effects of potassium hydroxide can include redness and a slight burning or itching sensation, which usually only lasts for a few minutes after the medication is applied.

Podophyllotoxin

Podophyllotoxin comes in liquid form and poisons the cells of the spots. A special application stick is used to draw up the correct dosage of liquid, which is then dripped onto each spot. You may experience some mild irritation.

The treatment will need to be applied for a few days, followed by a few days without treatment. This is referred to as a treatment cycle.

Imiquimod

Imiquimod is a cream that can be used to treat larger spots or large clusters of spots. It works by stimulating your immune system into attacking the spots. You apply the cream to the spots, then wash it off after 6-10 hours. This should be done three times a week.

It may take several weeks of treatment before you notice an improvement. Common side effects of imiquimod include:

• hard and flaky skin
• redness and swelling of the skin
• a burning or itching sensation after applying the cream
• headache 

These side effects are usually mild and should pass within two weeks of stopping treatment.

Benzoyl peroxide

Benzoyl peroxide is usually available in cream or gel form. It's applied to the spots once or twice a day, after washing and drying the affected area. Use benzoyl peroxide sparingly, because too much can harm your skin.

Benzoyl peroxide makes your skin more sensitive to sunlight, so either avoid excessive exposure to sunlight and ultra-violet (UV) light, or wear sun cream. Avoid getting the medication on hair and clothes, as it can bleach them. Wash your hands thoroughly after you finish applying the medication.

Common side effects of benzoyl peroxide include:

• dry and red skin
• a burning, itching or stinging sensation
• some peeling of the skin

These side effects are usually mild and should resolve after the treatment has finished.

Tretinoin

Tretinoin is available as a liquid that is applied once or twice a day to individual spots. As with benzoyl peroxide, tretinoin can make your skin sensitive to sunlight and UV light.

Tretinoin is not suitable for use during pregnancy because it can cause birth defects. It's important to use a reliable method of contraception while taking tretinoin if you are a sexually active woman.

The most common side effects of tretinoin are mild irritation and stinging of the skin. It may take several months before you notice an improvement in your symptoms.

Other treatments

There are a number of minor procedures that can help remove or destroy MC spots.

They can be painful, so are not generally suitable for children, and they must always be carried out by a suitably qualified healthcare professional.

Cryotherapy

Cryotherapy involves freezing the spots with liquid nitrogen to remove them. Each spot is frozen for 5-10 seconds, so that a layer of ice forms over the spot and surrounding skin.

You may need several sessions of cryotherapy before each spot clears completely. You will need to wait two to three weeks between each treatment session.

Diathermy

Diathermy uses heat to remove the spots. The area being treated is numbed with a local anaesthetic and a heated electrical device is used to burn off the spots.

Curettage

Curettage removes spots by scraping them off with a thin, metal, spoon-like instrument called a curette. As with diathermy, you may have a local anaesthetic before having this type of treatment.

Pulsed-dye lasers

Pulsed-dye laser treatment is a relatively new type of treatment for MC. It uses a powerful beam of light to destroy the cells that make up each spot. You may experience some skin discolouration and discomfort in the treated areas, but this should improve within a few weeks. The procedure may need to be repeated several times to clear all of your spots.

Pulsed-dye laser treatment uses expensive equipment and its availability on the NHS is limited. Therefore, you will probably have to pay privately for the treatment, which can be expensive.