Interventions for cutaneous molluscum contagiosum

Katariina Hannula-Jouppi

Level of evidence: B

No single intervention appears to promote the healing of molluscum contagiosum.

A Cochrane review was done on 22 randomised controlled studies on 1650 participants without immune deficiency «van der Wouden JC, van der Sande R, Kruithof EJ ym...»1. The studies examined the effects of topical (20 studies) and systemic interventions (2 studies).

Comparisons included physical therapies, as well as topical and oral treatments. Most studies were set in hospital outpatient or emergency departments, and were performed in North America, the UK, Asia, or South America. Participants were of both sexes and were mainly children or young adults. Follow-up duration varied from 3 to 28 weeks after randomisation. Only five studies had longer than 3 months' follow-up.

Moderate quality evidence showed that topical 5 % imiquimod was no more effective than vehicle in terms of clinical cure, but led to more application site reactions, and high-quality evidence that there was no difference between the treatments in terms of short-term improvement. However, high-quality evidence showed a similar number of general side effects in both groups.

Low-quality evidence, based on one or two mostly small studies, revealed the following results for the outcome short-term clinical cure: 5 % imiquimod less effective than cryospray or 10 % potassium hydroxide; 10 % Australian lemon myrtle oil more effective than olive oil; 10 % benzoyl peroxide cream more effective than 0.05 % tretinoin; 5 % sodium nitrite co-applied with 5 % salicylic acid more effective than 5 % salicylic acid alone; and iodine plus tea tree oil more effective than tea tree oil or iodine alone. More uncertain (low-quality) evidence was found to suggest that 10 % potassium hydroxide is more effective than saline; homeopathic calcarea carbonica is more effective than placebo; 2.5 % solution of potassium hydroxide is less effective than 5 % solution of potassium hydroxide; and 10 % povidone iodine solution and 50 % salicylic acid plaster are more effective than salicylic acid plaster alone.

No randomised trials were found for several commonly used treatments, such as expressing lesions with an orange stick or topical hydrogen peroxide.

As the evidence found did not favour any one treatment, the natural resolution of molluscum contagiosum remains a strong method for dealing with the condition. In people without an immune deficiency molluscum contagiosum is a self limiting disease

  • Study quality: High
  • Applicability: Good
  • Comment: The level of evidence is downgraded by the original trials’ study limitations (no blinding, many drop outs, no intention-to-treat-analysis).


  1. van der Wouden JC, van der Sande R, Kruithof EJ ym. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev 2017;5:CD004767 «PMID: 28513067»PubMed