Comprehensive Review of Molluscum Contagiosum in Children: Prevalence, Transmission, Clinical Features, and FDA-Approved Treatments

Hamdy M. Gomaa¹, Ghada M. Ghafagy², Solwan I. El-Samanoudy³, Emad A Taha⁴, Marwa D Hasan⁵

Molluscum contagiosum significantly affects children, necessitating effective treatments to manage symptoms, prevent complications, and improve quality of life.

Abstract

Background: Molluscum contagiosum (MC) is a common viral skin infection affecting school-aged children, with a prevalence of 2-8%. Although self-limited, MC often requires active management to prevent spread, scarring, and to address cosmetic and social concerns. Traditional treatments have various complications, and currently, only topical berdazimer gel and cantharidin are approved by the FDA. Methods: A comprehensive literature review was conducted to assess the prevalence, transmission, clinical presentation, complications, and treatment options for MC. The review included studies from various geographic regions, focusing on both physical and chemical treatment methods, as well as newer FDA-approved therapies. Results: MC is most prevalent in children aged 2-5, with no gender-specific differences. The infection manifests as skin-colored, dome-shaped papules, primarily on exposed skin. Complications include school exclusion, social isolation, and secondary infections. Treatment options vary widely in efficacy and safety. Physical treatments like curettage and cryotherapy are effective but can cause scarring and discomfort. Chemical treatments, including potassium hydroxide and cantharidin, offer non-invasive alternatives but have side effects. Newer treatments like topical berdazimer gel and cantharidin solution are promising due to their ease of use and lower complication rates. Conclusion: MC is a significant infection in children, often necessitating treatment due to its complications. While traditional treatments have notable drawbacks, FDA-approved topical therapies, berdazimer gel, and cantharidin, provide effective and safer options. Further research is needed to optimize treatment protocols and minimize adverse effects.

Keywords: Molluscum Contagiosum, Pediatric Skin Infections, Viral Skin Infection Treatment, Berdazimer Gel, Cantharidin

References

Chathra, N., Sukumar, D., Bhat, R., Kishore, B., Martis, J., Kamath, G., Srinath, M., & Monteiro, R. (2015). A comparative study of 10% KOH solution and 5% imiquimod cream for the treatment of Molluscum contagiosum in the pediatric age group. Indian Dermatology Online Journal, 6(2), 75. https://doi.org/10.4103/2229-5178.153005

Guan, H., Nuth, M., Zhukovskaya, N., Saw, Y. L., Bell, E., Isaacs, S. N., & Ricciardi, R. P. (2014). A novel target and approach for identifying antivirals against molluscum contagiosum virus. Antimicrobial Agents and Chemotherapy, 58(12), 7383–7389. https://doi.org/10.1128/AAC.03660-14

Gerlero, P., & Hernández-Martín, Á. (2018). Actualización sobre el tratamiento de moluscos contagiosos en los niños. Actas Dermo-Sifiliográficas, 109(5), 408–415. https://doi.org/10.1016/j.ad.2018.01.007

Hebert, A. A., Siegfried, E. C., Durham, T., de León, E. N., Reams, T., Messersmith, E., & Maeda-Chubachi, T. (2019). Efficacy and tolerability of an investigational nitric oxide-releasing topical gel in patients with molluscum contagiosum: A randomized clinical trial. Journal of the American Academy of Dermatology, 82(4), 887-894. https://doi.org/10.1016/j.jaad.2019.09.064

Kaye, K. S., Petty, L. A., Shorr, A. F., & Zilberberg, M. D. (2019). Current epidemiology, etiology, and burden of acute skin infections in the United States. Clinical Infectious Diseases, 68(S193–S199). https://doi.org/10.1093/cid/ciz002

Luigi Castelli, M. (2015). Molluscum contagiosum treated with systemic aciclovir: a case report. Global Dermatology, 2(4). https://doi.org/10.15761/god.1000145

Meza-Romero, R., Navarrete-Dechent, C., & Downey, C. (2019). Molluscum contagiosum: An update and review of new perspectives in etiology, diagnosis, and treatment. Clinical, Cosmetic and Investigational Dermatology, 12, 373–381. https://doi.org/10.2147/CCID.S187224

Qureshi, A., Zeb, M., Jalal-ud-din, M., Iqbal Sheikh, Z., Adeel Alam, M., & Abbas Anwar, S. (2016). Comparison of efficacy of 10% potassium hydroxide solution versus cryotherapy in treatment of molluscum contagiosum. Journal of Ayub Medical College Abbottabad, 28(2). http://www.jamc.ayubmed.edu.pk382

Saleh, R., Nada, E., Hamed, A. F., & Hussien, W. M. (2019). Epidemiologic Trends of Viral Skin Infections in Egypt: A Cross-Sectional Hospital-Based Study. Dermatology Research and Practice, 2019. https://doi.org/10.1155/2019/5469726

Silverberg, N. B. (2019). Pediatric molluscum: an update. Cutis, 104(5), 301-305. http://www.ncbi.nlm.nih.gov/pubmed/31886783

Singh, C., & Whittam, L. (2021). Diagnosis and management of common viral skin infections.

Stuart N Isaacs, M. (2023). Molluscum contagiosum.

U.S. Food and Drug Administration Approves ZELSUVMI™ as a First-in-Class Medication for the Treatment of Molluscum Contagiosum. Ligand Pharmaceuticals. January 5, 2024. https://investor.ligand.com/news-and-events/press-releases/news-details/2024/U.S.-Food-and-Drug-Administration-Approves-ZELSUVMI-as-a-First-in-Class-Medication-for-the-Treatment-of-Molluscum-Contagiosum/default.aspx

Uçmak, D., Akkurt, M. Z., Kacar, S. D., Sula, B., & Arica, M. (2014). Comparative study of 5% and 2.5% potassium hydroxide solution for molluscum contagiosum in children. Cutaneous and Ocular Toxicology, 33(1), 54–59. https://doi.org/10.3109/15569527.2013.796479

Vakharia, P. P., Chopra, R., Silverberg, N. B., & Silverberg, J. I. (2018). Efficacy and Safety of Topical Cantharidin Treatment for Molluscum Contagiosum and Warts: A Systematic Review. American Journal of Clinical Dermatology, 19(6), 791–803. https://doi.org/10.1007/s40257-018-0375-4