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February 10, 2012

Molluscum Contagiosum (cont.)

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How is molluscum contagiosum diagnosed?

The diagnosis of molluscum is based simply on the skin appearance. Most pediatricians and family physicians diagnose this condition during an in-office skin exam.

A few other medical conditions may look just like molluscum and need to be examined more closely by a dermatologist. A dermatologist may therefore be consulted for atypical cases of molluscum.

While typical cases do not require special tests, cases that are more difficult may warrant a relatively painless in-office skin scraping by a dermatologist using a microscope, glass slide, and potassium hydroxide to rapidly detect the small poxvirus particles. Rarely, a small skin biopsy may be used to help the doctor confirm the diagnosis.

Other times, a skin bacterial culture may be taken by a cotton-tip applicator to assist in detecting a secondary bacterial skin infection, such as Staphylococcus.

How is molluscum contagiosum treated?

There are many good treatment options for treating molluscum. Some physicians may also suggest not treating the molluscum contagiosum, allowing it to go away on its own. The specific treatment depends on the areas involved, number of bumps, age of the individual, and underlying health conditions.

Many available wart treatments are also used to treat molluscum. It is very important to keep in mind that regardless of the treatment, multiple and repeat treatments may be required to get rid of all of the molluscum. Treatments should be scheduled every two to three weeks for best results.

Home remedies for mild cases of molluscum include one or a combination of the following:

  • using an over-the-counter salicylic acid patch like Trans-ver-sal or Compound W;


  • self-freezing every two to three weeks with an over-the-counter home wart freezer device;


  • applying a very small piece of duct tape or electrical tape applied to the individual molluscum bumps daily; and/or


  • squeezing out the small center core of each bump.

Professional medical treatments may include one or a combination of the following:

  • freezing with liquid nitrogen, called cryotherapy;


  • burning using light electrocautery;


  • painlessly applying cantharidin "beetle juice" or "blister beetle fluid";


  • manually extracting the core using a special tool called a comedone extractor;


  • applying chemical acid;


  • surgically removing using a small, sharp, spoon-like instrument called a curette;


  • applying retinoid like tretinoin (Retin-A) or tazarotene (Tazorac) cream at home daily;


  • applying topical immune activating medications like imiquimod (Aldara) cream;


  • applying topical chemotherapy cream like 5-fluorouracil (Efudex or Carac);


  • applying topical antiviral medications like new Cidofavir cream (off-label use);


  • taking oral cimetidine (Tagamet) used for weeks to months for individuals with a large number of lesions (off-label use); and


  • using laser therapy in some cases.

Most cases of molluscum contagiosum are easily and fully curable. There are very rare, long-standing cases of molluscum contagiosum in immunocompromised people that may not be curable.



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