In most cases, molluscum contagiosum (MC) will clear up and heal within 18 months without any treatment.
However, MC can take longer to clear up in people who have a weakened immune system, such as those receiving chemotherapy for cancer or those who are HIV positive. In these circumstances, MC can take up to five years to clear.
Why routine treatment is not recommended
There are a number of treatments for MC that can help the infection to clear more quickly. However, routine treatment, particularly in children, is not usually recommended. This is because:
- the infection usually clears up on its own without any scarring
- the infection does not usually cause any symptoms (other than the lesions) and does not usually interfere with everyday activities
- treatment can be painful and cause scarring, which may upset and distress young children
Thus many GPs and dermatologists refuse to treat young children when there is no clinical need, because they feel that it would cause the child unnecessary pain.
Treatment is only usually recommended for adults and older children when the spots of MC are particularly ugly and are affecting the person’s quality of life. If this applies to you or your child, contact your GP as they can recommend one of the treatments outlined below.
Squeezing the lesions
Squeezing the lesions is the first and the simplest type of treatment for MC. The aim of squeezing the lesions is to remove the pearly grey core at their centre. This is the part that contains the molluscum contagiosum virus (MCV).
Do not try to squeeze the lesions before consulting your GP. If they advise you to squeeze the lesions, wash and dry your hands thoroughly both before and afterwards. After drying your hands on a towel, wash the towel immediately on the hot cycle of your washing machine.
If you do not follow these important hygienic precautions, the lesions may become infected by bacteria that are already present on your skin. Your GP can advise you about whether your child should have their spots squeezed or whether it is better to let the infection clear by itself.
Your GP can squeeze your or your child’s lesions, or they can train you to safely squeeze the lesions yourself. Your GP may use a small pair of forceps or tweezers to squeeze the lesions, but you may find it easier to use your fingers.
If you want to remove the cores of the lesions yourself, do it after you or your child has had a bath, as the skin will be softer. Wear disposable gloves, wash your hands before and afterwards, and carefully dispose of the contents of the lesions. If you use a pair of tweezers, remember to sterilise them afterwards using antiseptic solution.
An alternative to using tweezers is to use a wooden toothpick to tease out the core of the lesion. Afterwards, put the toothpick in the dustbin.
Removing the cores of the lesions can be painful, so it may be best to treat a small number at a time. Once the lesions have been treated and their contents removed, they are likely to heal within one to four weeks.
Other procedures
If removing the cores of the lesions does not work, other types of treatment can be used for MC. The following treatments can be painful, so they are not suitable for children. They must always be carried out by a healthcare professional and should never be attempted at home.
Cryotherapy
Cryotherapy involves freezing the lesions with liquid nitrogen to remove them. Each lesion is frozen for 5-10 seconds so that a layer of ice forms over the spot and surrounding skin.
You may need several sessions of cryotherapy before each spot clears completely. You will need to wait two to three weeks between each treatment session.
Diathermy
Diathermy uses heat to remove the lesions. After you have been given a local anaesthetic to numb the area being treated, your GP or nurse will use a heated electrical device to burn off the lesions.
Curettage
Curettage removes lesions by scraping them off with a thin metal instrument called a curette. As with diathermy, you may have a local anaesthetic to numb your skin before having this type of treatment.
Topical treatment
A number of topical treatments (creams, lotions and ointments) are sometimes used to treat cases of MC. All of these treatments were originally designed to treat other types of skin conditions, such as genital warts, acne and psoriasis, but they have since proven effective in treating some cases of MC.
The following topical treatments are usually given under the supervision of a dermatologist or another qualified healthcare professional, rather than your GP.
Podophyllotoxin
Podophyllotoxin comes in liquid form and poisons the cells of the lesions. A special application stick is used to draw up the correct dosage of the liquid, which is then dripped onto each lesion. You may feel some mild irritation when the liquid is applied to the lesion.
Treatment with podophyllotoxin is based on cycles. The first treatment cycle involves applying the medication twice a day for three days. This is followed by a rest cycle in which you have four days without treatment. Most people need four to five treatment cycles separated by rest cycles.
Imiquimod
Imiquimod is a cream that is usually recommended to treat larger lesions or large clusters of lesions. Imiquimod works by stimulating your immune system into attacking the lesions. You apply the cream to the lesions, then wash it off after 6-10 hours. This should be done three times a week.
It can often take several weeks of treatment before you notice an improvement in your symptoms. Common side effects of imiquimod include:
- hardening and flakiness of the skin
- swelling of the skin
- a burning or itching sensation after applying the cream
- headache
These side effects are usually mild and should pass within two weeks of stopping treatment with imiquimod.
Benzoyl peroxide
Benzoyl peroxide is usually available in cream or gel form and used either once or twice a day. It should be applied to all parts of your face that are affected by lesions, 20 minutes after washing. Use benzoyl peroxide sparingly as too much can harm your skin.
Benzoyl peroxide makes your skin more sensitive to sunlight, so avoid excessive exposure to sunlight and ultra-violet (UV) light, or wear sun cream.
Avoid contact with hair, clothes, towels and bed linen because benzoyl peroxide can bleach these materials. Wash your hands thoroughly after you finish applying the medication.
Common side effects of benzoyl peroxide include:
- dry and tense skin
- a burning, itching or stinging sensation
- some redness and peeling of the skin
The side effects are usually mild and should resolve after the treatment has finished. However, you should contact your GP if your side effects become troublesome as your dose may need to be adjusted.
Tretinoin
Tretinoin is available in gel or cream form and is applied once or twice a day to individual lesions. As with benzoyl peroxide, tretinoin can make your skin sensitive to sunlight and UV light.
Tretinoin is not suitable for use during pregnancy because it can cause birth defects. It is important to use a reliable method of contraception while taking tretinoin if you are a sexually active woman.
The most common side effects of tretinoin are mild irritation and stinging of the skin.
It can take several months of treatment with tretinoin before you notice an improvement in your symptoms.
Pulsed-dye lasers
A relatively new type of treatment for MC is pulsed-dye laser treatment. This involves using a powerful beam of light to destroy the cells that make up each individual lesion. Afterwards, a bruise is left. It should heal within one to two weeks. Most people only need one or two sessions of pulsed-dye laser treatment to clear their lesions.
One practical disadvantage of pulsed-dye laser treatment is that it involves using expensive equipment. Availability is therefore limited on the NHS. Priority will be given to people who have more severe skin conditions, such as disfiguring birthmarks.
You are likely to have to pay privately for pulsed-dye laser treatment. The cost of treatment will depend on how many shots of the laser are required. An average session usually costs around £100-£200.
