RISK FACTORS: Close personal contact with infected persons, In children, transmission can occur from swimming pools, In adults, sexual transmission is common, Immunocompromised individuals
In adults, is often a sexually transmitted disease.
GENERAL MEASURES Spontaneous resolution common in 6-24 months. Individual lesions often
resolve in 2 months.
SURGICAL MEASURES
. The level of evidence for all surgical treatments is expert opinion or clinical experience. Options include:
. Cryotherapy until halo of ice appears, and then thaw and repeat freeze
. Curettage alone or followed by electrodesiccation under local or topical anesthesia
. Expression of pearly core, either manually or using forceps
. Piercing with an orange stick, with or without the application of tincture of iodine or phenol
. For recalcitrant lesions, especially in HIV infected patients, the use of lasers has been reported
DRUG(S) OF CHOICE
. Many medical regimens have been suggested for the treatment of molluscum contagiosum, most of which
have a level of evidence only of expert opinion or clinical experience. Options include:
. Imiquimod cream - 1% or 5% applied topically 1 or 2 times daily 3 times a week for 4-16 weeks
. Podofilox cream - 0.5% applied topically daily for up to 4 weeks
. Potassium hydroxide - 5% or 10% applied topically twice daily for up to 6 weeks
. Salicylic acid/lactic acid home treatments
. Tretinoin cream or gel home treatments
. Trichloroacetic acid treatment in the office
. Podophyllin treatment in the offi ce
. Occlusion with duct tape (as for common warts) has also been reported
. In addition, for recalcitrant lesions, especially in HIV infected patients, treatment with antiretrovirals such as
cidofovir has been reported
PATIENT MONITORING Recheck in 4 to 6 weeks after treatment begun for development of new lesions. Two to 4 visits are often required for complete course of treatment (with offi ce-based treatments).
PREVENTION/AVOIDANCE In adults, avoid sexual contact with infected individuals
POSSIBLE COMPLICATIONS
β’ Autoinoculation is common
β’ Contagious to others
β’ Immunocompromised individuals may have extensive infections
EXPECTED COURSE/PROGNOSIS
β’ Recurrences are uncommon in immunocompetent individuals, but may occur
β’ Lesions in HIV infected patients are more recalcitrant
β’ Incubation variously estimated at 14 days to 6 months
β’ Lesions enlarge slowly and may reach 5-10mm in 6-12 weeks
β’ After trauma or spontaneously, lesions eventually crust and resolve
β’ Total resolution is variable, most self-limiting within 6-9 months, but some persist 3-4 years
β’ Some experts recommend no treatment, especially for children, but a Cochrane review is currently underway
evaluating all treatments, including waiting for natural resolution