Dermatología Pediatrica

A Prospective Randomized Trial Comparing the Efficacy and Adverse Effects of Four Recognized Treatments of Molluscum Contagiosum in Children  

Dominique Hanna, M.D.,* Afshin Hatami, M.D., F.R.C.P.C.,  Julie Powell, M.D.,
F.R.C.P.C.,  Danielle Marcoux, M.D., F.R.C.P.C.,  Catherine Maari,
M.D., F.R.C.P.C., Pascal Savard, M.D., F.R.C.P.C.,  Huguette Thibeault, R.N.,  and Catherine McCuaig, M.D., F.R.C.P.C.  *CHU Sherbrooke,  CHU Me`re-Enfant Sainte-Justine, University of Montreal, Montreal, Quebec, Canada

Abstract:

Molluscum contagiosum is a common viral disease of childhood  presenting as small, firm, dome-shaped umbilicated papules. Although benign and generally self-limited, this condition is contagious and can lead to complications such as inflammation, pruritus, dermatitis, bacterial superinfection, and scars. No consensus has been established concerning the management of this condition. We conducted a prospective randomized study comparing four common treatments for molluscum contagiosum in 124 children aged 1 to 18 years. One group was treated with curettage, a second with cantharidin, a third with a combination of salicylic acid and lactic acid, and a fourth with imiquimod. Patients needing, respectively, one, two, or three visits for treatment of their mollusca were: 80.6%, 16.1%, and 3.2% for curettage, 36.7%, 43.3%, and 20.0% for cantharidin, 53.6%, 46.4%,  and 0% for salicylic acid and glycolic acid, and 55.2%, 41.4%, and 3.4% for  imiquimod. The rate of side effects was 4.7% for group 1, 18.6% for group 2,  53.5% for group 3, and 23.3% for group 4. Curettagewas found to be themost  efficacious treatment and had the lowest rate of side effects. It must be  performed with adequate anesthesia and is a time-consuming procedure.

Cantharidin is a useful bloodless alternative particularly in the office setting, but hasmoderate complications due to blisters and necessitatedmore visits  in our experience. The topical keratolytic used was too irritating for children.
 
Topical imiquimod holds promise but the optimum treatment schedule has  yet to be determined. Finally, we believe that the ideal treatment for mollusca  depends on the individual patient preference, fear, and financial status,  distance from the office, and whether they have dermatitis or blood-borne infections.

Pediatric Dermatology 23 (6), 574-579.