Molluscum Contagiosum Treatments and Medications

Molluscum contagiosum is a viral skin infection that causes raised spots or bumps on the skin. There’s usually no need to worry since symptoms of the infection go away on their own within 6 months to a year. Molluscum contagiosum is, however, very contagious, so it pays to visit a doctor, get a diagnosis, and take positive measures to make sure no one else gets infected.

What is molluscum contagiosum?

Molluscum contagiosum, or water warts, is a common but harmless viral skin infection. Infected skin tissues typically erupt in a cluster of one to three dozen small bumps or pimples (papules) called “Mollusca” that may become itchy, red, dry, or sore. The infection usually clears on its own without scarring in six to 12 months but may persist for up to four years. The molluscum contagiosum virus does not lie dormant within the body; therefore, symptoms that return indicate a new infection. Complications are not common but may include bacterial infections or worsening of eczema around the area affected by molluscum contagiosum.

The molluscum contagiosum virus (MCV) responsible for the infection belongs to the poxvirus family. The virus infects the upper skin layer, called the epidermis, which is constantly being shed and replaced with new skin cells. It does not spread through the blood or bodily fluids.

The virus is primarily spread through direct skin-to-skin contact, including sexual contact. People can reinfect themselves on other parts of their body by touching, rubbing, scratching, or squeezing the lesions. A molluscum infection can also be spread indirectly through contaminated objects, such as towels, bedclothes, toys, razors, and similar objects. Once caught, the infection has an incubation period of two to seven weeks before bumps start to appear.

Molluscum is a common infection, especially in warm, humid, or crowded areas. Both adults and children can become infected with molluscum contagiosum. Up to 5% of children in the United States get molluscum infections, and as many as one in three adults have been exposed to the virus. Some people are more at risk than others, especially those with atopic dermatitis or compromised immune systems.

Molluscum contagiosum infections are usually acquired by young children between the ages of two and five. In children, the lesions often appear on the face, trunk, shoulders, or limbs. Among teens and adults, molluscum is usually spread through sexual contact or contact sports. Sexually-transmitted molluscum infections typically appear on the genital area, anus, inner thighs, and lower abdomen. People with compromised immune systems may have lesions spread extensively around the body.

How is molluscum contagiosum diagnosed?

Molluscum contagiosum is diagnosed by a general practitioner or dermatologist primarily by examining the bumps.

The symptoms of molluscum contagiosum are limited to the appearance of the skin lesions, which usually appear in a cluster of a dozen or more bumps that are:

• Pearly, pink, or purple-colored

• Dome-shaped

• About one-tenth to less than one-half an inch in diameter

• Firm, with a dimple in the center

The healthcare provider may need to examine the lesions with a dermatoscope, a small, handheld magnifier with light. If there’s any doubt, the doctor can confirm the infection using a specialized microscope or a skin biopsy.

Molluscum contagiosum treatment options

Molluscum warts typically disappear on their own without scarring within a few months. Dermatologists may treat the condition if the infection is extensive, located on the genitals, or cosmetically disruptive. When determining treatment options, a specialist may also consider whether the patient has a weakened immune system or other risk factors.

Physical removal

A dermatologist can physically remove the molluscum warts using a variety of outpatient procedures:

• Cryotherapy. Using liquid nitrogen, a dermatologist will freeze the molluscum lesions to remove them. The procedure has a high success rate at clearing lesions and can be performed without anesthesia.

• Curettage. The dermatologist will apply a topical anesthetic and remove the infected lesions with a curette, or a type of pick. Povidone iodine may be applied to the area afterward to prevent infection. Curettage can be highly successful, but there is a risk of scarring.

• Laser therapy. Using a pulsed dye laser, a concentrated beam of light is focused on the molluscum lesion, removing it with heat.

Chemical removal

Certain chemical treatments involving glycolic acid or lactic acid can be used to help get rid of molluscum bumps. However, these chemicals can irritate the skin and cause redness or swelling. Chemical treatments should be administered by a dermatologist and may require several visits to completely treat the lesions.

Medications

Immune-modulating drugs can be successful at ramping up the immune system’s fight against the virus. These medications can be taken orally or applied topically to the infected area. For severe infections or patients with a weakened immune system, a doctor may inject certain drugs to clear the molluscum infection.

Molluscum contagiosum medications

Because most molluscum contagiosum infections go away naturally in six to 12 months, many dermatologists are wary of treating the condition with drugs. It is not entirely certain that drugs help, so a dermatologist will make a judgment based on the patient’s situation. First-line therapies often include topical medications that destroy the infected lesions. For extensive or stubborn infections, dermatologists may turn to drugs that stimulate the immune system.

Topical agents

Cantharidin, a blistering agent, is often the first-line medical therapy used by a dermatologist. Because cantharidin can irritate the skin and cause blisters, it is applied to the infected area by a dermatologist as an office procedure. It must be washed off in two to six hours to prevent skin damage and scarring. Blisters form in one or two days. If effective, the molluscum infection will clear within seven days after application.

The dermatologist may prescribe any number of other drugs to help clear the molluscum skin lesions: podophyllotoxin cream, salicylic acid, benzoyl peroxide, tretinoin cream, or potassium hydroxide. Many of these medications are common acne treatments. Unlike cantharidin, these are medications that may be applied daily for several weeks.

Immunomodulators

Immunomodulating drugs stimulate the immune system to more effectively fight the molluscum virus. A common front-line therapy for molluscum is topical imiquimod, particularly for sexually-transmitted molluscum infections. When applied to the infected skin area, imiquimod provokes an inflammatory response that destroys the lesions.

Young children may be prescribed cimetidine, an over-the-counter tablet normally used to reduce stomach acid. Cimetidine works by blocking histamine, which is known to suppress certain immune cell activity. Unlike some topical medications, cimetidine does not carry a risk of skin irritation or scarring.

Antiviral medications

For patients with extensive infections and a weakened immune system, cidofovir may be used off-label to directly stop the growth of the molluscum virus. It is administered as a topical cream or an intravenous infusion.

What is the best medication for molluscum contagiosum?

For most people with healthy immune systems, molluscum contagiosum goes away within six to 12 months. Medications may help the infection clear up faster, although treatment will be determined on a case-by-case basis. There is, then, no “best” medication for molluscum contagiosum. A dermatologist will weigh the severity of the infection, the patient’s overall medical situation, and the risk of side effects in determining the most appropriate drug treatment, if any.

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Best medications for molluscum contagiosum