Published on in Vol 6 (2023)

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From the Cochrane Library: Interventions for Cutaneous Molluscum Contagiosum

From the Cochrane Library: Interventions for Cutaneous Molluscum Contagiosum

From the Cochrane Library: Interventions for Cutaneous Molluscum Contagiosum

Research Letter

1University of Colorado School of Medicine, Aurora, CO, United States

2Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States

3Department of Dermatology, Rocky Mountain Regional Veterans Affairs Medical Center, Eastern Colorado Health Care System, Aurora, CO, United States

Corresponding Author:

Ani Oganesyan, BA

University of Colorado School of Medicine

13001 E 17th Pl

Aurora, CO, 80045

United States

Phone: 1 8184416860


Molluscum contagiosum (MC) is a cutaneous and mucosal condition that primarily affects children and immunocompromised adults. It presents with skin-colored, dome-shaped papules on the skin and may be associated with pain, pruritus, erythema, and, rarely, bacterial superinfection. Although spontaneous resolution generally occurs, treatment may be indicated for cosmetic purposes or to prevent spread.

A 2017 Cochrane systematic review [1] evaluated 22 randomized controlled trials (N=1650 participants, aged 0-36 years) and sought to provide an evidence base supporting specific treatments. Inclusion criteria required participants to have a clinical diagnosis of MC, excluding those with immune deficiency or sexually transmitted MC, as well as assessment of physical ablative methods (curettage, cryotherapy), topical agents (potassium hydroxide, iodine, trichloroacetic acid, salicylic acid, 10% phenol/70% alcohol, tretinoin, oils, cantharidin, podophyllotoxin, imiquimod), and systemic therapy (cimetidine, 35 mg/kg per day; calcarea carbonica, daily for 15 days).

The primary outcome was short‐term clinical cure, defined as the complete disappearance of lesions up to 3 months after the initiation of treatment, as assessed by a physician. The secondary outcomes were clinical cure up to and beyond 6 months, time to cure, recurrences (after 3, 6, and 12 months), adverse effects (pain, blistering, sensitization, scarring, erosion, and pigmentary changes), spread, and disease‐related quality of life.

The treatment comparisons performed in the included studies are summarized in Table 1. Data from this review strongly support awaiting spontaneous resolution of molluscum lesions and demonstrated that 5% imiquimod was no more effective in terms of clinical cure than the placebo (with an identical vehicle). Furthermore, the use of 5% imiquimod was reported to be more harmful regarding application site reactions and no more effective than its vehicle over a 3-month period.

Newer studies have proposed novel treatment options. Notably, a 2020 case study and literature review [2] described the effectiveness of photodynamic therapy (2 sessions, 2 weeks apart using 630-nm red light lasting 9 minutes) in association with incubation with 5’-Aminolevulinic acid in completely resolving giant MC (larger than 1 cm in diameter). An alternate review by Wells et al [3] discussed intralesional immunotherapies in the treatment of MC and highlighted case reports exhibiting resolution rates between 36% and 100% with minimal adverse reactions (erythema, mild edema) with Candida antigen, MMR (measles, mumps, and rubella) vaccine, vitamin D3, and OK- 432 (a penicillin- and heat-treated lyophilized powder of the Streptococcus pyogenes A3 substrain). A retrospective cohort study by Chauhan et al [4] assessed 22 patients between the ages of 6 to 50 years treated with 1 to 3 doses of 0.5 ml of intralesional MMR. They found that 18 (81.8%) patients had complete clearance of lesions and 4 (18.18%) patients had a partial response of more than 50% clearance. This benefit was observed in both injected and distant lesions in both studies.

Limitations of these studies include their observational design and lack of a control group. Furthermore, these studies did not equally delineate the time frame in which the participants experienced the lesions, nor whether the participants’ results were affected by other dermatologic diagnoses. There is a need for larger, placebo-controlled, and prospective studies using both intralesional immunotherapy and phototherapy to confirm their efficacy.

Table 1. Treatment comparison with respective results and statistics.
5% imiquimod vs cryosprayPhysician assessmentCryotherapy was superior1 study, Na=74; RRb 0.60, 95% CI 0.46-0.78
5% imiquimod vs 10% potassium hydroxidePhysician assessmentPotassium hydroxide was superior2 studies, N=67; RR 0.65, 95% CI 0.46-0.93
5% imiquimod vs placeboPhysician assessmentNeither intervention was superior4 studies, N=850; RR 1.33, 95% CI 0.92-1.93
Topical 10% Australian lemon myrtle oil vs olive oilPhysician assessment10% Australian lemon myrtle oil was superior1 study, N=31; RR 17.88, 95% CI 1.13-283
10% benzoyl peroxide cream vs 0.05% tretinoinPhysician assessment10% benzoyl peroxide cream was superior1 study, N=30; RR 2.20, 95% CI 1.01-4.79
5% sodium nitrite coapplied with 5% salicylic acid vs 5% salicylic acid alonePhysician assessment5% sodium nitrite coapplied with 5% salicylic acid was superior1 study, N=30; RR 3.50, 95% CI 1.23-9.92
Iodine plus tea tree oil vs tea tree oilPhysician assessmentIodine plus tea tree oil was superior1 study, N=37; RR 0.20, 95% CI 0.07-0.57
Iodine plus tea tree oil vs iodine alonePhysician assessmentIodine plus tea tree oil was superior1 study, N=37; RR 0.07, 95% CI 0.01-0.50
Homeopathic calcarea carbonica vs placeboPhysician assessmentNeither intervention was superior1 study, N=20; RR 5.57, 95% CI 0.93-33.5
2.5% potassium hydroxide solution vs 5% potassium hydroxide solutionPhysician assessmentNeither intervention was superior1 study, N=25; RR 0.35, 95% CI 0.12-1.01
10% povidone-iodine solution plus 50% salicylic acid plaster vs salicylic acid plaster alonePhysician assessmentNeither intervention was superior1 study, N=30; RR 1.43, 95% CI 0.95-2.16

aN: number of participants.

bRR: risk ratio.

Conflicts of Interest

RD is a joint coordinating editor for Cochrane Skin, a dermatology section editor for UpToDate, a social media editor for the Journal of the American Academy of Dermatology, a podcast editor for the Journal of Investigative Dermatology, editor-in-chief of JMIR Dermatology, and a coordinating editor representative on Cochrane Council. TS is an editorial board member at large for JMIR Dermatology.

RD receives editorial stipends (JMIR Dermatology, Journal of Investigative Dermatology), royalties (UpToDate), and expense reimbursement from Cochrane.

  1. van der Wouden JC, van der Sande R, Kruithof E, Sollie A, van Suijlekom-Smit LW, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev 2017 May 17;5(5):CD004767 [FREE Full text] [CrossRef] [Medline]
  2. García-Gil MF, Morales-Moya AL, Monte-Serrano J, Ramírez-Lluch M, Iliev H, Ara-Martín M. Antimicrobial photodynamic therapy in the treatment of giant molluscum contagiosum: a case report and review of the literature. Dermatol Ther 2021 Jan 10;34(1):e14635. [CrossRef] [Medline]
  3. Wells A, Saikaly SK, Schoch JJ. Intralesional immunotherapy for molluscum contagiosum: a review. Dermatol Ther 2020 Nov 20;33(6):e14386. [CrossRef] [Medline]
  4. Chauhan P, Jindal R, Meena D. Intralesional measles, mumps, and rubella vaccine immunotherapy in molluscum contagiosum: a retrospective observational study from a tertiary care center in north India. Dermatol Ther 2021 Jan 09;34(1):e14615. [CrossRef] [Medline]

MC: molluscum contagiosum
MMR: measles, mumps, and rubella

Edited by R Alhusayen; submitted 28.07.22; peer-reviewed by S Quinn, J Yu, J Solomon, K Ashack, A Truss; comments to author 01.04.23; revised version received 03.04.23; accepted 12.04.23; published 25.04.23


©Ani Oganesyan, Torunn E Sivesind, Robert Dellavalle. Originally published in JMIR Dermatology (, 25.04.2023.

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