Current Dermatology Reports

https://doi.org/10.1007/s13671-020-00289-z

INFECTIOUS DISEASE AND DERMATOLOGY (C BEARD AND K. KRISHNAMURTHY, SECTION

EDITORS)

Molluscum Contagiosum: Review and Update on Clinical

Presentation, Diagnosis, Risk, Prevention, and Treatment
Gabrielle Robinson 1 & Steven Townsend 2 & Marla N. Jahnke 1,2,3

# Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
Purpose of Review Molluscum contagiosum (MC) is a self-limited cutaneous viral infection that most commonly affects children
and immunocompromised populations. This review provides an update on the clinical manifestations, risk, diagnosis, treatment,
and prevention of this frequently encountered infection.
Recent Findings A recent Cochrane review concluded that there is insufficient evidence to establish the superiority of any
specific treatment modality or to confirm that active intervention is superior to benign neglect (van der Wouden JC et al.,
Cochrane Database Syst Rev 5:CD004767, 2017). Interim pilot study data suggests that cantharidin outperforms placebo
(Guzman AK et al., Int J Dermatol 57:1001–1006, 2018). Imiquimod is no longer recommended for treatment of MC (van
der Wouden JC et al., Cochrane Database Syst Rev 5:CD004767, 2017; Papadopoulos EJ, https://www.fda.gov/files/drugs/
published/N20-723S020-Imiquimod-Clinical-BPCA.pdf, 2006; Katz KA et al., Pediatr Dermatol 35:282–283, 2018).
Summary Optimal management strategies for MC remain unclear due to the multitude of proposed therapies, lack of high-quality
evidence, and uncertain benefit of intervention for uncomplicated disease. Aside from watchful waiting, destructive therapies
such as cantharidin and curettage are among the best studied methods and remain the treatment of choice for most patients.

Keywords Molluscum contagiosum . Cantharidin . Cryotherapy . Poxvirus . Umbilicated papule

Introduction
Molluscum contagiosum (MC) is a self-limited cutaneous in-
fection caused by the molluscum contagiosum virus of the
Poxviridae family. This condition is most commonly encoun-
tered in pediatric and immunocompromised patients, present-
ing with distinctive pearlescent white papules with a central
umbilication. Infection is transmitted either through direct
contact with infected skin, via fomites, or by autoinoculation.
This article is part of the Topical Collection on Infectious Disease and
Dermatology
* Marla N. Jahnke
mjahnke1@hfhs.org
1
Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
2
Wayne State University School of Medicine, Detroit, MI, USA
3
Children’s Hospital of Michigan, Detroit, MI, USA
While numerous therapies have been proposed for the treat-
ment of MC, there are no consensus guidelines regarding best
practice. In this article, we have incorporated the most recent
evidence to provide an updated review of the clinical presen-
tation, risk, diagnosis, prevention, and treatment of MC.
Epidemiology
Preschool and elementary school age children are most
commonly affected with prevalence peaking around
6 years of age. Occurrence before 1 year of age is rare
[1–3]. The sex-ratio is approximately equal, with limited
evidence suggesting a slight male predominance that has
been attributed to higher rates of participation in contact
sports among boys [4, 5]. A 2014 meta-analysis of cross-
sectional surveys found the overall prevalence of MC
among children to be 5.1–11.5%, with geographic areas
with warm climates being more heavily affected [6].
Prevalence among children in the United States is estimat-
ed at less than 5% [3]. Among adults, MC is most

commonly seen in the setting of underlying immunodefi-
ciency, particularly human immunodeficiency virus (HIV)
positivity, or as a sexually transmitted infection in immu-
nocompetent individuals [5–8]. There is no recent epide-
miologic data on the prevalence of MC in healthy adults,
but prevalence among persons with HIV is estimated at 5–
18% [9].
Clinical Presentation
MC classically presents as discrete, pearly white to pink,
dome-shaped, umbilicated papules ranging from 1 to 5 mm
in size (Fig. 1). Lesions often occur in clusters or a linear
distribution due to autoinoculation [10, ]. Any site can be
affected but palmoplantar and mucous membrane involve-
ment is rare [2]. Lesions are usually asymptomatic but may
cause pruritus, sometimes with an associated perilesional ec-
zematous reaction referred to as “molluscum dermatitis” [11].
Cases of pale hypopigmented rings around MC lesions (so-
called Woronoff rings) have also been reported [12].
In children, MC tends to favor the trunk (69.5%) and ex-
tremities (48.4%) more than the head (24.2%) [3]. While the
number of lesions can vary greatly, the lesion count is usually
less than 20 at presentation [10]. Multi-site involvement is
common, and genital involvement in this context is typically
the result of autoinoculation from another site [13]. Isolated
genital involvement is unusual and should prompt consider-
ation of sexual transmission [1]. Infection during the neonatal
period is rare and is most often transmitted vertically during
delivery. In these instances, MC lesions may appear in a cir-
cular arrangement on the scalp [14].
Teenage and adult patients more often present with in-
volvement of the anogenital region, reflecting acquisition
through sexual contact [15]. Healthy adults will typically have
only a few lesions. In contrast, HIV-positive individuals may
suffer from much more extensive disease or MC with atypical
features such as predominant facial involvement, giant lesions
Fig. 1 Photograph of MC on the thigh of a 7-year-old female
Curr Derm Rep
(lesions > 1 cm), and lesions mimicking other entities such as
abscesses, ecthyma, verruca, nevus sebaceus, or keratinocyte
carcinoma [9, 16].
Infection in immunocompetent individuals tends to be self-
limited, customarily resolving within 6–9 months but poten-
tially persisting for over 3 years [17•]. There is no evidence
that spontaneous regression occurs in HIV-positive patients
without correction of their underlying immunodeficiency [9].
Risk
MC has been associated with a number of risk factors includ-
ing the use of swimming pools, shared bathing accessories
(i.e., bath towels and sponges) [18], having an affected house-
hold contact [19], living in impoverished [20] or overcrowded
environments [21], and comorbid atopic dermatitis (AD) or
immunodeficiency. Swimming behavior, AD, and immunode-
ficiency are discussed further below.
Swimming and Bathing Behaviors
Multiple observational studies have suggested a link between
swimming and bathing behavior and MC [22, 23]; however,
this association remains controversial [2, 24]. In a 2005 survey
study of 198 patients with clinically confirmed MC, swim-
ming in a school swimming pool and sharing a bath sponge
or towel with an affected individual were the only swimming
and bathing behaviors significantly associated with the spread
of MC infection. No association was found between MC in-
fection and the use of home swimming pools or spas, public
pools, or sharing a bath tub with a MC-infected person [18]. A
subsequent study by Osio et al. (n = 650, ages 6 months–
15 years) again failed to detect an association with swimming
pool use; however, a history of bathing with siblings was
found to be associated with a higher MC lesion count [1].
Atopic Dermatitis
Patients with AD are thought to be at higher risk of MC. This
is based largely on observational evidence that the prevalence
of AD among children diagnosed with MC exceeds the esti-
mated prevalence of AD in the general population [2, 11, 25•,
26]. Patients with AD have also been reported to suffer from
more extensive and refractory disease, attributed to
autoinoculation from scratching compounded by baseline
compromise in skin barrier function and relative suppression
of the type 1 helper T cell response [27–30]; studies, however,
evaluating the prevalence, relapse rate, and MC lesion count
between children with and without AD have been inconsistent
[1, 4, 11, 31, 32] leading some authors to question whether the
differences in prevalence simply reflect sampling bias due to
Curr Derm Rep
the fact that children with AD are more likely to be evaluated
by a dermatologist [3, 11].
Immunodeficiency
Patients with HIV or other forms of impaired cellular immu-
nity are disproportionately affected by MC [9, 33, 34]. MC are
a clinical marker of advanced HIV infection, increasing in
incidence when CD4 counts drop below 200/mm3 [9]. Case
studies suggest that correction of CD4 counts with initiation of
antiretroviral therapy may lead to the resolution of MC
[35–37]. Despite being a well-established marker of
immunocompromise in adults, there is little epidemiologic
data to support this association in children [1, 3, 38].
Anecdotal evidence suggests that immunosuppressed children
are prone to more recalcitrant disease, similar to their adult
counterparts [38].
Diagnosis
Diagnosis is usually made by clinical examination. If neces-
sary, dermoscopy can be used to help visualize the character-
istic central umbilication and may reveal other supporting fea-
tures such as polylobular amorphous yellow-white structures
and peripheral crown vessels (Fig. 2) [39]. A potassium hy-
droxide (KOH) prep similar to a fungal scraping can also be
performed for quick in-clinic confirmation of diagnosis. The
extruded core of an MC lesion is crushed between two glass
slides and then treated with 10% KOH. After allowing several
minutes for keratinocyte degradation, clusters of round
Henderson-Paterson bodies can be visualized (Fig. 3) [40].
Handheld reflectance confocal microscopy may also be used
to identify lesions, however, use is limited by equipment cost,
poor availability, and the need for specialized training for im-
age interpretation [41, 42].
Fig. 2 Polarized dermoscopic image of MC demonstrating a crown of
branched vessels surrounding amorphous white globules with a central
opening
Fig. 3 Potassium hydroxide preparation of MC showing Henderson-
Paterson bodies
Biopsy for histopathologic study should be reserved for
cases where there is diagnostic uncertainty. Microscopic exam
shows a well-circumscribed lobulated lesion with a
crateriform acanthotic epidermis, downward displacement of
the basement membrane, and characteristic large eosinophilic
cytoplasmic inclusions (Henderson-Paterson bodies) that dis-
place the nucleus against the cell membrane creating a signet
ring appearance. There is often surrounding fibroedematous to
fibromyxoid stroma (Fig. 4) [43].
Prevention
MC is best prevented by avoiding direct skin-to-skin contact
with an infected individual. Shared use of potential fomites
such as towels, bathing accessories, clothing, and bed linens
should also be avoided [, 18]. The phenomenon of vertical
transmission has not been adequately studied, but disruption
of the neonatal skin during delivery has been postulated to
contribute to disease development [14]. Therefore, early iden-
tification of at-risk mothers and avoidance of trauma during
delivery may help minimize the risk of transmission.
Treatment
The question of when and how to treat MC is controversial
given the self-limited nature and the multitude of treatments
with little evidence supporting their use. A retrospective study
evaluating the resolution rate of MC in treated versus untreat-
ed patients found no statistically significant difference in rates
of complete resolution at 12 and 18 months (45.6% vs 48.4%
and 69.5% vs 72.6%, respectively), calling into question
whether active treatment impacts overall disease course [32].
Active non-intervention is a viable and frequently recom-
mended strategy [44]; however, many patients and families
seek treatment due to fear of transmission to close contacts,

Fig. 4 Molluscum contagiosum
pathology. a Low-power
hematoxylin and eosin staining of
MC with a characteristic cup-
shaped lesion with a scalloped
deep border and surrounding
fibroedematous stroma. b High-
power view highlighting
numerous large, intracytoplasmic,
eosinophilic inclusion bodies
(Henderson-Paterson bodies)
anxiety about spreading of lesions, social stigma, unaccept-
able cosmesis, pruritus, or other concerns [2, 45•]. The deci-
sion to treat should be made on a case-by-case basis but is
generally indicated for patients with extensive disease, sec-
ondary complications (i.e. bacterial superinfection, conjuncti-
vitis, or molluscum dermatitis), psychological distress, cos-
metic concerns, or genital involvement to prevent sexual
transmission [46].
To date, there are no FDA-approved therapies for MC.
While many different treatments have been proposed, efficacy
data is largely limited to small case series and uncontrolled
studies [47•]. Randomized controlled trials are scarce and
have failed to demonstrate significant differences in efficacy
between the various treatment modalities [17•]. Ultimately,
treatment choice is guided by factors such as patient age and
skin type, the number and anatomic location of lesions, patient
or family preference, and provider experience. General pre-
cautions and specific interventions are discussed further
below.
General Precautions
All patients should be counseled about general precautions to
prevent the spread of MC. This includes avoiding scratching
and rubbing the lesions to prevent autoinoculation, keeping
lesions covered when possible, and abstaining from sharing
potential fomites (see “Prevention”) with uninfected persons.
The data on the risk of transmission through swimming pools
Curr Derm Rep
and shared bathing is mixed [1, 2, 18, 22, 23]. While it seems
prudent that patients refrain from these activities until the in-
fection has cleared, it is not always reasonable due to the long
disease duration. Therefore, patients should attempt to cover
lesions as much as possible. Contact sports (i.e., wrestling)
should likewise be avoided [48]. MC is not an indication to
keep children home from school or daycare and documenta-
tion clearing patient attendance should be provided when nec-
essary [24].
Mechanical Methods
Cryotherapy
Cryotherapy is one of the most common interventions for MC.
Liquid nitrogen is applied with a cryotherapy gun or cotton tip
swab for 1–2 cycles, typically every 2–4 weeks [44]. Benefits
of cryotherapy include speed and ease of administration, low-
cost, and widespread availability. Unfortunately, it is often
poorly tolerated by young children due to pain during appli-
cation and may result in adverse effects such as erythema,
itching, erosions, pigmentary changes, and scarring [49]. In
a prospective, randomized, comparative trial between
imiquimod and cryotherapy (n = 74), 70.3% of patients treated
with weekly applications of cryotherapy achieved complete
clearance by week 3 and 100% of patients by week 6 [49].
No statistically significant difference in cure rate was detected
between imiquimod and cryotherapy. A later comparative
Curr Derm Rep
study between cryotherapy and 10% KOH (n = 30) found that
93.3% of patients receiving weekly cryotherapy achieved
complete response after 4 weeks but concluded that 10%
KOH was preferred given equivalent efficacy with lower risk
of post-inflammatory dyspigmentation [50].
Curettage
Physical removal by curettage is an effective method of treat-
ment for MC lesions in the appropriate patient [51–53].
Adverse effects include pain, minor bleeding, and scarring
[54]. In a recent retrospective study by Harel et al. (n =
1879), 70% of children achieved complete clearance of MC
after one session of curettage and an additional 26% cleared
after two treatments. Satisfaction rates among parents and
children were high (97%) [55•]. Reported recurrence rates
following curettage are variable, ranging from 0 to 66%.
[31, 51]. Pre-treatment with a topical anesthetic such as
EMLA (eutectic mixture of local anesthetic composed of com-
bination 2.5% lidocaine and 2.5% prilocaine) 1 hour prior to
the procedure may help minimize associated pain [55•], how-
ever, patient fear may still be prohibitive. For cooperative
children whose parents appear capable and interested, topical
anesthetic and a disposable curette can be provided so that
treatments may be continued at home [51], although this prac-
tice is extremely provider and patient dependent.
Pulsed Dye Laser
There have been several reports of successful treatment of
MC with pulsed dye laser (PDL) [56, 57]. However, this
modality is typically reserved for recalcitrant cases given
the associated cost and poor availability. The theorized
mechanism of action is laser ablation of the vasculature
feeding the MC as well as non-selective thermal damage
to the MC itself. In a prospective, non-randomized pilot
study (n = 19), 84.3% of children treated with PDL cleared
after a single laser treatment (wavelength 585 nm, pulse
duration 0.45 ms, spot diameter 7 mm; energy density 6–
7 J/cm2) and only one patient required three treatments to
achieve complete remission [56]. While generally safe and
well-tolerated, potential adverse effects include pain, ery-
thema, pigmentary changes, and rarely scarring [58].
Manual Extrusion
Manual extrusion of MC nuclei using gloved fingers or for-
ceps is an easy, inexpensive, and fast method of treatment for
MC that is recommended as first-line therapy by some authors
[59, 60]. Patients and caregivers can perform this at home after
proper instruction, including specific counseling on the con-
tagious nature of the core. Risks of treatment are similar to
curettage and include minor bleeding and scarring [61], as
well as spread of the virus.
Chemical Methods
Cantharidin
Cantharidin is a vesicant derived from the blister beetle (Lytta
vesicatoria) that causes intraepidermal blister formation with-
in 24–48 hours of application. For treatment of MC, a prepa-
ration of 0.7–0.9% cantharidin is applied to lesions with the
blunt end of a cotton swab (with or without occlusion) and
washed off in 2–4 hours [54]. This cycle is repeated at 2–4-
week intervals. Cantharidin has been shown to be safe, effec-
tive, painless, and is often considered the treatment of choice
for young patients. Patient and parent satisfaction rates are
consistently high [44, 45•, 54, 62]. Reported cure rates, how-
ever, are variable—ranging from 15.4 to 100% [63•]. One
double-blind, placebo-controlled trial (n = 29, ages 5–
10 years old) concluded that 0.7% cantharidin offered mini-
mal benefit compared to vehicle after five treatments over
2 months (RR 2.46, 95% CI 0.25 to 24.21) [64]. In contrast,
a more recent and larger prospective, randomized, double-
blind, placebo-controlled trial (n = 94, ages 2–17 years old)
found that treatment with cantharidin was associated with a
reduction in mean lesion count as well as higher rates of com-
plete clearance compared to placebo at 6 weeks (36.2% vs
10.6%, P = 0.0065) [65•,17]. Of note, cantharidin was applied
for 6 hours (compared to the typical 2–4 hours), which the
authors suggest may account for the superior outcome com-
pared to prior studies. Disadvantages to cantharidin include
delayed onset pain, pruritus, bacterial superinfection of rup-
tured blisters, and pigmentary changes. Some providers avoid
the use of cantharidin for facial MC given the risk of blistering
and dyspigmentation; however, one retrospective review of 62
cases of pediatric facial MC treated with cantharidin (45%
white, 26% black, 20% Middle Eastern, 9% other) found no
cases of permanent dyspigmentation or scarring, concluding
that cantharidin may still be considered for facial MC in the
hands of experienced providers after appropriate discussion
with parents regarding potential risks [45•].
Potassium Hydroxide
Multiple studies have shown topical KOH to be beneficial,
with an efficacy similar to curettage and cryotherapy [17•,
66, 67•, 68, 69•]. An aqueous solution of KOH is applied at
concentrations of 5–15% every other day to twice daily for
1 week or until inflammation develops [66, 67•, 68]. KOH is
attractive as a simple, non-invasive treatment option that can
be applied at home. Disadvantages include skin irritation,
burning, and mild erythema [67•, 69•]. In a double-blind, ran-
domized, clinical trial (n = 53, ages 2–6 years old) comparing

the efficacy of once daily application of 10% KOH, 15%
KOH, and placebo, both 10% KOH and 15% KOH were
found to be superior to placebo, with clearance rates of
58.5%, 64.3%, and 18.8%, respectively. No statistically sig-
nificant difference in efficacy was detected between 10%
KOH and 15% KOH, but 10% KOH was better tolerated by
patients [67•].
Topical Retinoids
There have been two small randomized controlled trials com-
paring topical retinoids with other topical therapies, including
10% benzoyl peroxide cream (n = 30) and 5% KOH (n = 50).
Saryazdi et al. noted complete clearance of lesions in 5 of 15
patients treated with twice daily tretinoin 0.05% cream for
6 weeks, but found tretinoin to be slightly inferior in efficacy
to twice daily 10% benzoyl peroxide application [70].
Rajouria et al. noted a reduction in mean lesion count after
4 weeks of once daily tretinoin 0.05% cream, however, at a
slower rate than patients treated with once daily 5% KOH
[71]. Adverse effects of topical retinoids include dryness, mild
erythema, pruritus, and burning sensation [70, 71].
Miscellaneous Chemical Methods
Other chemical preparations that have been used for the treat-
ment of MC include podophyllin [8], trichloroacetic acid [72],
glycolic acid [73], silver nitrate [74], salicylic acid [75],
sinecatechins ointment [76], and dilute povidone-iodine [77].
Immunomodulatory Methods
Imiquimod
Although imiquimod has historically been used in the treat-
ment of MC, two large randomized, double-blind, vehicle-
controlled trials completed in 2006 (currently unpublished)
failed to demonstrate any benefit over placebo [78]. A 2017
Cochrane review concluded that imiquimod was no better
than placebo for short-term (3 months) improvement or
long-term (> 6 months) cure of MC, and was furthermore
associated with more adverse effects such as pain, blistering,
scarring, and pigmentary changes [17•]. Therefore,
imiquimod is no longer recommended for the treatment of
MC [79•].
Oral Cimetidine
Cimetidine is an H2-receptor antagonist of proposed benefit
for MC based on the theory that it may enhance cell-mediated
immunity via blockade of the H2-receptors present on T-
suppressor cells. In a study by Dohil et al., 9 out of 12 patients
treated with a 2-month course of oral cimetidine at 40 mg/kg/
Curr Derm Rep
day experienced clearance of all lesions [80]. However, a sub-
sequent randomized controlled trial found cimetidine no more
effective than placebo in terms of cure or improvement after
4 months of treatment at 35mg/kg/day [81]. Adverse effects of
cimetidine include nausea, diarrhea, rash, and dizziness.
Candida Antigen
There is limited evidence to support the use of Candida anti-
gen for the treatment of MC. A retrospective review examin-
ing the efficacy of intralesional Candida (n = 25, ages 2–
15 years old) found that after an average of 2.64 treatments
of monthly injection with 0.3 mL Candida antigen, 56% of
patients had complete resolution, 28% had partial response,
and 16% had no improvement. However, 5 of the 14 patients
who experienced complete resolution were receiving concur-
rent cryotherapy [82]. A later retrospective review (n = 29)
found that 55% of patients treated with monthly intralesional
Candida antigen (0.3 mL administered to a maximum of three
lesions) achieved complete clearance of both local and remote
lesions after an average of 2.5 treatments. Partial response was
witnessed in 37.9% [83]. Adverse effects of intralesional can-
dida include injection site pain, pruritus, swelling, erythema,
blistering, and pigmentary changes [82, 83].
Antiviral Methods
There have been several case reports of patients with extensive
or refractory MC being successfully treated with either topical
cidofovir (1–3% preparation applied either daily or 5 days per
week) or intravenous cidofovir (2–5 mg/kg weekly for 2 weeks
followed by every 2 weeks). Intravenous use is limited by risk
of nephrotoxicity. Safety and efficacy in children have not yet
been established [84–87].
Traditional Medicine
Many different homeopathic therapies have been used to treat
MC, including East Indian sandalwood [88], topical evening
primrose [89], Melaleuca (tea tree oil) [90], Australian lemon
myrtle oil [91], and a variety of Chinese traditional medicines
[]. Other used but unstudied remedies include apple cider vin-
egar, oregano oil, and Thuja. While not well-validated, these
therapies are relatively benign and families who prefer to pur-
sue natural remedies may seek out these formulations.
Counseling should be provided regarding the possibility of
allergic contact sensitization to Melaleuca, the epileptogenic
potential of Thuja (as well as several other essential oils) [92],
and the risk of irritant contact dermatitis associated with many
of these therapies.
Curr Derm Rep
Emerging Therapies
Case studies and small pilot studies have reported treatment
benefit with intralesional 5-fluorouracil [93], autoinoculation
[94], zoster immunoglobulin [95], ingenol mebutate [96], hy-
drogen peroxide [97], systemic interferon alpha [98–100], and
localized hyperthermia [101]. Viswanath et al. reported the
case of an immunocompetent adult with recalcitrant MC
who cleared (with scarring) after six cycles of weekly
intralesional 5-fluorouracil [93]. An uncontrolled prospective
study (n = 58) found that one session of autoinoculation (re-
peated puncturing of a single MC lesion with an insulin nee-
dle) led to complete clearance in 55.2% of patients within
3 months, partial response in 32.8%, and no improvement in
12.1% [94]. There has been a single reported case of a 5-year-
old child on methotrexate who experienced near complete
clearance of MC after receiving post-exposure zoster immu-
noglobulin [95]. A recent open-label, comparative pilot study
(n = 19) reported remission of MC in 9 of 10 patients treated
with ingenol mebutate 0.015% gel applied on three consecu-
tive days per week for up to 12 weeks compared to 3 of 9
patients treated with 5% imiquimod applied five times weekly
[96]. An uncontrolled, open, pilot study (n = 21) found that
1.8% hydrogen peroxide gel applied twice daily under occlu-
sion for 3 weeks led to complete remission in 14.3% of pa-
tients and a decrease in lesion count in 85.7% of patients [97].
There are a handful of cases of MC being successfully treated
with systemic interferon alpha in patients with primary and
acquired immunodeficiency [98–100]. Finally, Gao et al. re-
cently conducted a pilot study (n = 21) investigating the use of
local hyperthermia to treat MC. A hyperthermia device with
an infrared emitting source was used to heat targeted lesions to
a skin surface temperature of 44 °C. Treatment sessions were
30 minutes in duration and were administered on a weekly
basis for up to 12 weeks. Of the 18 patients who completed
therapy, 12 experienced complete clearance within 12 weeks,
two experienced a greater than 50% reduction in lesion count,
and four had a less than 50% reduction in lesion count [101].
Our Approach
The decision to treat MC requires careful discussion with the
patient and/or family. Even though MC self-resolves, parents
often express frustration and desire for treatment. Thus, it is
prudent to consider treatment in many cases. While the evi-
dence does not strongly support that treatments routinely has-
ten resolution, treatment usually decreases the number of le-
sions present and often improves any associated symptoms.
Improvement in these factors is often paramount in helping
patients and parents achieve their goals for seeking care.
When there is a desire for intervention, the treating physician
must bear in mind the importance of shared decision-making.
This requires reviewing multiple possible treatment modalities
that he or she has available and deems appropriate for the
patient based on age, location of the lesions, lesion count, skin
type, and temperament of the patient and reviewing expected
outcomes. Additionally, precautions should be discussed to
prevent the spread of MC.
Conclusion
MC is a common viral dermatosis of childhood and frequent
reason for dermatologic consult. Despite its ubiquity, much
controversy remains regarding optimal management. While
numerous treatments exist, the quality of available evidence
is generally low and insufficient to establish superiority of any
specific intervention. Given the self-limited nature of the dis-
ease, the decision of whether or not to treat should be made on
a case-by-case basis after discussion with patients and their
families. Treatment selection should be made with the goal of
minimizing pain and scarring and take into account patient
factors. Cantharidin and curettage are among the best studied
treatment options and are considered treatments of choice for
most patients who seek treatment in the office. General pre-
cautions to prevent the spread of MC should be discussed with
patients and caregivers regardless of whether active treatment
is to be pursued.
Compliance with Ethical Standards
Conflict of Interest Dr. Jahnke declares no conflict of interest. Dr.
Robinson declares no conflict of interest. Steven Townsend declares no
conflict of interest.
Human and Animal Rights and Informed Consent This article does not
contain any studies with human or animal subjects performed by any of
the authors.
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