Journal of Dermatological Treatment, 2014; 25: 246–248
© 2014 Informa Healthcare USA on behalf of Informa UK Ltd.
ISSN: 0954-6634 print / 1471-1753 online
DOI: 10.3109/09546634.2012.697988
ORIGINAL ARTICLE
Treatment of pediatric molluscum contagiosum with 10% potassium
hydroxide solution

lu, Mukaddes Kavala, Zafer Turkoglu, Ilkin Zindancı & Sibel Sudogan
Burce Can, Filiz Topalog
Department of Dermatology, University of Medeniyet Goztepe Training and Research Hospital, Istanbul, Turkey
Background: Molluscum contagiosum (MC) is a common cutaneous
viral infection of the skin that is frequently seen in children.
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Although lesions can resolve spontaneously, treatment is
mandatory because of the psychological effect of widespread
lesions in children. Potassium hydroxide (KOH) is a strong alkali
that has been used by dermatologists for a long time in identifying
the fungal infections from skin scrapings. Aims: We evaluated
40 children with MC for the safety and efficacy of treatment with
topical 10% KOH aqueous solution. Methods: Parents were
instructed to apply a 10% KOH aqueous solution, twice daily,
with a cotton stick to all lesions. Treatment was continued till the
lesions showed signs of inflammation or superficial ulceration.
Assessments of response and side effects were performed at the
end of week 2, week 4, week 8 and week 12. Results: We found
For personal use only.
complete clearance of lesions in 37 (92.5%) patients receiving
topical 10%KOH solution after a mean period of four weeks. Three
children dropped out of the study; two children reported severe
stinging of the lesions and discontinued the treatment; the other
patient developed hypopigmentation during the treatment. Local
side effects were observed in 12 children (32.4%). Conclusion: Even
though 10% KOH solution is associated with some local side
effects, it is a safe, effective, inexpensive and noninvasive
alternative treatment of MC in children.
Key words: molluscum contagiosum, therapy, viral infection
Introduction
Molluscum contagiosum (MC) is a common worldwide viral
infection mainly seen in young children. It is caused by the
Molluscipox virus and is transmitted by direct skin-to-skin
contact and fomites. The typical clinical MC lesion is a small,
flesh-colored firm umbilicated papule with a smooth surface (1).
Although most lesions resolve spontaneously in 6 to 18 months
without therapy, most patients need therapy because of the
psychological effect of widespread lesions. Therefore, treatment
of the lesions is frequently required (2).
Therapeutic modalities for MC are mainly based on destructive
type of treatment such as curettage, cryotherapy and cantharidin.
These treatment options are not well tolerated by children owing
to pain and fear (3,4). Potassium hydroxide (KOH) is an alkali
that penetrates and destroys the skin by dissolving the keratin. On
the other hand, it can cause an irritant reaction in the skin,
according to the concentration used, body region on which it is
Correspondence: Burce Can, Department of Dermatology, University of Medeniyet Goztepe Training and Research Hospital, Güvenç Sok.
_
No:23 Da:2 Göztepe/ Istanbul, Turkey. Tel: +0090216566400 9126. Fax: +00902163857272. E-mail: drburcecan@yahoo.com
(Received 29 February 2012; accepted 30 April 2012)
applied and individual susceptibility (5). Studies showed that
KOH solution was an effective and safe therapy for MC in
children (2,6). In this study we aimed to confirm these findings
and evaluate the efficacy and side effects of 10% KOH aqueous
solution in children having MC.
Materials and methods
The study was approved by the local ethics committee at our
hospital. Informed consent was obtained from the parents of all
children. Forty patients aged between 2 and 15 years, attending
the pediatric dermatology outpatient department, presenting with
clinical features of MC were included in the study. Children with
MC were treated with topical 10% KOH aqueous solution. No
other therapeutic procedures with systemic or topical agents were
used during this treatment. The inclusion criteria was the pres-
ence of minimum one lesion in patients who were willing to
follow up. Children with known immunodeficiency or periorbital
lesions were excluded in this study. Information about age, sex,
number of lesions, location of involvement, history of atopy and
previous treatment was noted. Parents were instructed to apply a
10% KOH aqueous solution, twice daily, with a cotton stick to all
lesions. They were recommended to apply a small amount of
solution to avoid irritation of the normal skin. If any irritation
would happen, they were advised to wash the skin with water
instantly. Treatment was continued till the lesions showed signs of
inflammation or superficial ulceration. The assessment of ther-
apeutic response was consulted at the initial visit and at the end of
week 2, week 4, week 8 and week 12. The end point of the study
was complete clearance of lesions. The patients followed up for an
additional 3 months after clearance of all the lesions.
Results
In this study, 40 children were treated with topical 10% KOH
aqueous solution, twice a day, till all the lesions showed clearance.
Five patients (12.5%) had a history of atopy. Fifteen of 40 children
(37.5%) were females and 25 of them (62.5%) were males. Twenty-
three children (57.5%) were having lesions on one site of the body,
whereas in 17children (42.5%),multiplesites were involved (Table I).
Thirty-seven patients (92.5%) completed the study. All
these children achieved complete clearance of the lesions after
a mean period of 4 weeks (Figures 1 and 2). The development
of inflammation and ulceration time changed according to the
sizes and locations of the lesions. No recurrences were found
 Treatment of pediatric molluscum contagiosum 

Table I. Demographic features, efficacy and localized adverse effects of patients treated with 10% KOH aqueous solution.
Patient No. Age (y) Sex Location Duration of therapy Side effects
1 8 F Face, neck 4 wk (all cleared) -
2 8 M Scrotum 4 wk (all cleared) -
3 15 M Neck, trunk, arms 8 wk (all cleared) -
4 12 F Face 2 wk (all cleared) Transitory hyperpigmentation
5 8 M Face, neck 2 wk (all cleared) Persistent hyperpigmentation
6 5 M Chin 4 wk (all cleared) -
7 7 F Face 2 wk (all cleared) -
8 5 F Face 2 wk (all cleared) Persistent hyperpigmentation
9 3 M Face, trunk 2 wk (all cleared) -
10 7 M Face 4 wk (all cleared) Transitory hyperpigmentation
11 4 M Chin 4 wk (all cleared) Persistent hyperpigmentation
12 6 M Face, trunk 4 wk (all cleared) Transitory hypopigmentation
13 3 F Face, neck Noncompliant Severe stinging
14 2 M Neck Noncompliant Severe stinging
15 8 F Face 4 wk (all cleared) -
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16 10 M Face, neck, trunk 8 wk (all cleared) -

17 9 M Face 4 wk (all cleared) Secondary infection
18 8 M Face 4 wk (all cleared) Transitory hypopigmentation
19 6 M Trunk 4 wk (all cleared) -
20 3 F Trunk 8 wk (all cleared) -
21 10 F Legs 2 wk (all cleared) -
22 7 M Face, neck, trunk 12 wk (all cleared) -
23 5 F Chin, neck 12 wk (all cleared) Secondary infection
24 4 F Legs 4 wk (all cleared) Severe stinging
25 4 M Face, trunk 8 wk (all cleared) -
26 3 M Face, trunk Noncompliant Persistent hypopigmentation
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27 4 M Trunk 4 wk (all cleared) -

28 2 F Trunk 2 wk (all cleared) -
29 3 M Face, trunk, scrotum 4 wk (all cleared) -
30 4 M Face 2 wk (all cleared) Severe stinging
31 3 M Face, trunk 4 wk (all cleared) -
32 7 M Face, legs 2 wk (all cleared) -
33 6 M Face 2 wk (all cleared) -
34 3 M Trunk, scrotum 2 wk (all cleared) -
35 2 M Trunk 2 wk (all cleared) -
36 3 F Face, trunk 4 wk (all cleared) -
37 11 F Trunk 4 wk (all cleared) -
38 13 M Trunk 2 wk (all cleared) -
39 2 F Trunk, neck 4 wk (all cleared) Hypertrophic scar
40 2 F Face 2 wk (all cleared) -

during follow-up period. Most of the children suffered from a
mild stinging sensation lasting for 1 to 2 min after the application.
Two children dropped out the study who did not comply with the
treatment because of reporting severe stinging at application sites.
A third patient, who developed hypopigmentation during the
treatment, dropped out of the study.
At the end of the study, local side effects were observed in
12 children (32.4%). Five of them complained from hyperpigmen-
tation (13.5%), two of them from hypopigmentation (5.4%), two of
them from severe stinging sensation (5.4%), two of them from
secondary infection (5.4%) and one of them from hypertrophic
scar (2.7%). No significant difference in side effects was seen in
patients with atopy. Only six children (15%) had a history of previ-
ous treatment, whereas 34 children (85%) had no treatment. Number
of the lesions in these children varied from 1 to 59 (mean 14.8).
Discussion
Molluscum contagiosum is caused by MC virus, which is a
member of Molluscipox genus. Molluscum contagiosum virus
causes a benign cutaneous infection in humans (1). In patients
who are immune competent, MC virus is a self-limited viral
infection that resolves spontaneously, but in patients with
immune dysregulation, such as atopic dermatitis the lesions
can be more diffuse, remain for a long period of time and can
be more resistant to therapy (7). In our study five patients (12.5%)
had a history of atopy.
Molluscum contagiosum can be left untreated because most of
the lesions may regress spontaneously; however, most of the
parents of the children want to get rid of the papules because
of the unwanted cosmetic image. Spontaneous resolution of the
lesions take between 6 and 18 months to regress which can affect
the social life of the children in a negative way (8).
Many treatment modalities such as curetage, liquid nitrogen,
cantharidin, podophyllin, podophyllotoxin, salicylic acid/lactic
acid, phenol, tretinoin, silver nitrate, trichloroacetic acid and
oral cimetidine have been employed with variable results (1).
Recently reported treatments include electric cautery, imiquimod,
carbon dioxide or pulsed-dye laser and topical photodynamic
therapy (9–12).
  B. Can et al.
Figure 1. Molluscum contagiosum lesions on the neck of a 8-year-old girl.
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Potassium hydroxide is routinely used by dermatologists to
identify fungal elements in skin scrapings. Potassium hydroxide,
which is strongly alkaline, is effective in MC by dissolving keratin
and destroying the skin. It can also cause an irritant reaction in the
skin varying with the concentration, body region and individual
susceptibility (2).
Of 40 children with MC, 37 (92.5%) completed the study with
clearance of all the lesions. Parents continued to apply the
solution until inflammation or superficial ulceration became
evident. Most of the children reported a stinging sensation for
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1 to 2 min shortly after applying the solution. Because of the
severe stinging, two patients dropped out of the treatment. A child
with MC also dropped out of the study due to hypopigmentation.
About 18.9% of the patients who responded to the treatment
developed hyper- or hypopigmentation after treatment, which
most of them resolved spontaneously by time.
All parents reported that it was easy to apply the solution at
home to their children rather than using a more aggressive
therapy such as electric cautery or cryosurgery applied at the
hospital.
Our study shared similar results with report of Romiti et al., in
which 10% KOH solution was used in the treatment of MC also
(2). Our results showed a higher rate of complete clearance than
did the previous report of Romiti et al. (2) (92.5% vs 91.4%). The
side effects of the treatment with 10% KOH solution were
common. In order to reduce the side effects of the KOH treat-
ment, Romiti et al. also reported a study in which patients were
instructed to use 5% KOH solution twice a day. By reducing the
concentration of the solution they found 5% KOH as effective and
less irritating when compared to 10% KOH (2,6).
Spontaneous clearing of MC lesions during our study cannot
be excluded. A study with a low-dose concentration of KOH can
be necessary to reduce the number of the side effects of KOH
treatment. However, topical KOH solution is a effective, safe and
low-priced, noninvasive treatment modality of MC in children,
inducing a rapid clearance of lesions like in our study.
Declaration of interest: The authors report no conflicts of
interest. The authors alone are responsible for the content and
writing of the paper.
Figure 2. The same patient after 1 month of treatment. All lesions have
disappeared.
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