Should you Treat your Molluscum?

Should I treat my Molluscum or wait for it to go away on it’s own?  While molluscum does go away on it’s own for most people want it gone yesterday and will opt for treatment as long as the treatment isn’t worse than the disease.  While your medical provider may recommend treatment or non treatment the choice will be yours. For very limited uncomplicated cases waiting for it to go away on it’s own is an option.  The factors below usually make people want to seek treatment

  • Social Stigma and many visible lesions;  If you or your child’s self esteem being damaged, they are being teased at school or other parents are telling their children to avoid your child treatment should be considered
  • Stopping it from spreading to other areas of the body or other people:  If your child has eczema or is a picker, reducing the number of lesions through treatment will definitely help to stop it from spreading.  Adults don’t experience itching from Molluscum. Younger children often say they itch and pick at them. If the lesions are in areas where other kids can easily touch them and spread the disease, consider treatment.  Having other children at home that you don’t want it to spread to is a good reason to treat. For adults not spreading it sexually and resuming a normal sex life are the main motivators to get treatment
  • preventing scarring and secondary infection:  If the lesions are frequently painful and tend to get infected or inflamed consider treatment
  • The molluscum sufferer is engaged in contact sports:  Since this virus spreads mostly through skin to skin contact, grappling sports and contact sports can spread it to other participants.
  • You can’t stand looking at them another day (psychological distress):  We are hardwired to be disturbed by infections looking things on our skin.  Some people more than others. They questions to ask yourself is how much will it bother you to look a the molluscum lesions on yourself or your child for the next 6-12 months or longer

Treatments

Our medications are the best treatment option for most patients with molluscum.  However no one treatment is right for everyone and for many reasons you may seek treatment at your doctor or pediatrician.  The information below tells you everything you need to know about the most common treatments you may be offered and some insider knowledge gained from 15 years of treating molluscum!

The Cochran Reveiw is the world leader in medical study reviews.  They gather all the current data on medical treatment and analyze it.  Their opinions are considered to be very accurate and not biased. They  had this to say in their 2017 after their review Molluscum Contagiosum treatment.

“No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. We found moderate‐quality evidence that topical 5% imiquimod was no more effective than vehicle in terms of clinical cure, but led to more application site reactions, and high‐quality evidence that there was no difference between the treatments in terms of short‐term improvement. However, high‐quality evidence showed a similar number of general side effects in both groups. As the evidence found did not favour any one treatment, the natural resolution of molluscum contagiosum remains a strong method for dealing with the condition.”  Translation: their opinion is that the current treatment don’t work that well and have their own side effects so no treatment (letting them go away on their own) may be the best option.

Topical medications

Topical retinoids (tretinoin, Differin, Tazerotene, Aldabra, salicylic acid) are skin irritants but they are not strong enough to actually destroy the destroy the lesions.  The theory is that the irritation or destruction of the molluscum lesion causes An immune reaction that enables your body to kill more molluscum and shorten the outbreak. Problem is they don’t.  These topicals also don’t stay on the molluscum lesion and spread to unaffected skin causing widespread irritation. If they do manage to destroy a lesion it will take over a week of applications an cause a lot of irritation.  This treatment can definitely be worse than the disease.

Cantharidin

This is a topical medicine that is applied in the doctors office.  Used more by dermatologists than any other specialty. It is the extract of a blistering beetle.  It is painless to apply and writhing 24 hours the skin blisters. The blister is larger than the lesions sometimes considerably so. Some people experience blistering that is too much for their children to bear most peoples report that the blistering is manageable.  Make sure your provider is experienced with this medication. The first time it is put on the number of lesions treated should me minimal to gauge a patient reaction and tolerance to the treatment and then more can be treated next visit. The downside of this treatment is the healing time for the blisters and the fact that new lesions are growing between visits and you have to wait to have them treated until you return for additional treatments.  Also on olive skin patients the skin color is disrupted and this treatment can leave dark spots that last for months before fading away. The use of this on the face, especially of olive skin patients should be done very cautiously.

Cryotherapy (freezing)

Freezing is painful and is rarely tolerated by patients less than 7.  Molluscum lesions are small a q-tip or cryotweesers should be used to precisely apply the freezing.  If done precisely and carefully healing is faster than with Cantharidin but the patient must be able to tolerate the pain and hold perfectly still.  So if you child is able to do this treatment I would recommend it over Cantharidin if it is applied precisely and not sprayed with a cryogun. As with Cantharidin, this treatment does not shorten the outbreak and you have to wait till the next visit to treat new lesions that come up

Curettage

This involves scraping the lesion off with a curette.  Topical numbing medicine is typically used or else it is too painful.  If you child has a good pain tolerance and can keep very still this is a good method.  No other skin is damaged except the molluscum bump if done carefully. As with other treatments this does not shorten the overall outbreak time and you will have to wait until the next visit to treat new lesions that come up. 

Everyone has their own preferences.  I personally think that if the patient can tolerate curretage then they can definitely tolerate freezing using a cryotweesers which is less painful and less traumatizing to the skin.  Not every office has a cryotweesers.