Molluscum contagiosum - Treatment 

Treating molluscum contagiosum 

Squeezing the spots

Squeezing the spots that develop after a molluscum contagiosum infection is not recommended because it can cause pain and bleeding and it is likely to leave scarring. It also increases the risk of spreading the infection.

Most cases of molluscum contagiosum (MC) clear up without treatment after 12-18 months.

However, MC can take much longer to clear up in people with weakened immune systems, such as those with HIV or AIDs, or those having chemotherapy treatment for cancer. In these circumstances, MC can take up to five years to clear.

Routine treatment is not recommended

A number of treatments are available for MC that can help the infection clear up more quickly. However, routine treatment is not usually recommended, particularly for children. This is because:

  • the infection usually clears up on its own without scarring
  • the infection does not usually cause any symptoms, other than the spots, and it does not usually interfere with daily activities, such as work, swimming, or playing sports 
  • treatment can be painful, it can leave scarring, and it may be upsetting for young children 

Many GPs and dermatologists will not treat young children with MC if they feel that it would cause the child unnecessary pain and distress.

Treatment is usually only recommended for adults and older children who have spots that are particularly unsightly and are affecting their quality of life.

If this applies to you or your child, your GP may be able to recommend one of the treatments described below.

Topical treatments

There are a number of topical treatments (creams, lotions and ointments) that can be used to treat 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 (a specialist in treating skin conditions) or another qualified healthcare professional.

Potassium hydroxide

Topical 5% potassium hydroxide is a strong alkali that comes in liquid form. It has recently become available for MC in the UK on prescription or over-the-counter from pharmacists.

Potassium hydroxide works by breaking down the skin cells around the virus, allowing the immune system to respond to it.

The liquid is applied twice a day on each lesion, for around 4-6 days. The lesions should eventually become inflamed, before healing and disappearing within 1-5 weeks.

Side effects of potassium hydroxide can include:

  • hardening and flakiness of the skin
  • swelling of the skin
  • a burning or itching sensation after applying the cream

These side effects are usually mild and often related to the inflammation process necessary to begin the healing process. However, you should contact your GP if you have side effects that become troublesome.

Podophyllotoxin

Podophyllotoxin comes in liquid form and poisons the cells of the spots. A special application stick is used to draw up the correct dosage of the liquid, which is then dripped onto each spot. You may experience some mild irritation.

Treatment with podophyllotoxin is based on cycles. The first cycle involves applying the medication twice a day for three days. This is followed by four days without treatment. Most people need four or five treatment cycles separated by rest cycles.

Imiquimod

Imiquimod is a cream that may be used to treat larger spots or large clusters of spots. It works by stimulating your immune system into attacking the spots. You apply the cream to the spots before washing it off after 6-10 hours. This should be done three times a week.

It may 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 spots, 20 minutes after washing. Use benzoyl peroxide sparingly because 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

These side effects are usually mild and should resolve after the treatment has finished. However, you should contact your GP if you have side effects that become troublesome. Your dose may need to be adjusted.

Tretinoin

Tretinoin is available as a gel or cream 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 may take several months of treatment with tretinoin before you notice an improvement in your symptoms.

Other treatments

The following treatments can be painful, so they are not suitable for children. They must always be carried out by a suitably qualified healthcare professional and should never be attempted at home.

Cryotherapy

Cryotherapy involves freezing the spots with liquid nitrogen to remove them. Each spot 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 spots. 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 spots.

Curettage

Curettage removes spots 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.

Pulsed-dye lasers

Pulsed-dye laser treatment is a relatively new type of treatment for MC. It uses a powerful beam of light to destroy the cells that make up each spot. A bruise is left which should heal within one to two weeks. Most people only need one or two sessions of pulsed-dye laser treatment to clear their spots.

Pulsed-dye laser treatment uses expensive equipment and its availability on the NHS is limited. Therefore, priority is given to people who have 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 needed. An average session usually costs around £100-£200.


Page last reviewed: 24/09/2012

Next review due: 24/09/2014

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Comments

The 13 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Lizziep42 said on 16 March 2014

My daughter developed these spots when she was 8 -the first one appeared as a small red dot on her nose and then a few weeks later they started to appear on her neck as skin coloured raised spots. We went to the GP on 2 occasions and on both occasions we were given the relevant details and assured that the spots would go on their own and that there was no treatment. Then they spread to her inner arm and elbow . In all she had them for 18 months and at no time did they reduce in size or number. My daughter was a very confident and outgoing child but became very self conscious and seemed to lose a lot of her confidence. Finally I visited the GP again and insisted on a referral to a dermatologist. She was brilliant - she gave 3 options and my daughter chose the less painful potassium hydroxide treatment. It's expensive but worked a treat - visible improvements happened within days of first treatment and within 6 weeks all the lesions were gone. If I had realised there was this relatively painless and easy solution I would have opted for this route immediately and saved a lot of my daughters distress.

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User741318 said on 19 January 2013

Can I pay privately for treatment using the pulsed-dye laser when the spots are located on the penis/ penis shaft? I need to eradicate this problem for many reasons.

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Musto said on 02 October 2012

The molluscum contagiosum topic has recently been reviewed and updated. The previous advice about squeezing the spots that are caused by the infection has been corrected. They should not be squeezed due to the risk of spreading the infection and scarring.

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Jimbob092 said on 22 September 2012

I understand that a lot of people have had bad experiences with popping the MC.

However for those reasons, I don't believe that advice should be removed from this article.
I have the MC virus on the genital area, waiting it out does affect my quality of life. Needless to say, my GP did suggest I wait for my body to get rid of it on its own.

But when I popped some lesions, My experience was fine. The lesions were gone, no spreading at all and I'm still popping the remaining ones. Maybe the fact I'm popping them while in the shower has something to do with the lack of spreading.
If you're going to pop the MC, make sure you're somewhere where you will be able to wash before, and after e.g. the shower. I recommend staying in the shower till the bleeding stops, to be safe.

Though I need to wait for 4 weeks to see if its healed as per se the article. Though had 2 on my pelvic area that I removed the same way, and I never got them back.

I'm going to give the tea tree oil and iodine spray method a go after reading the latest comment.

As a last resort (or if all the methods seem uncomfortable), I'd recommend trying to get a prescription for Aldara, which helps your body's immune system get the virus; MC escapes your immune system's radar as it only infects the top layer of the skin.

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farnold said on 14 September 2012

RH999 I tried your advice on my daughter and it really did work using the tea tree and iodine spray. I used Savlon iodine spray. Within a few days the white stuff in the spots had gone and the spots scabbed over and then started to fade. I dabbed the tea tree directly onto the spots rather than put it in the bath. I made my daughter bathe every other day rather than every day to try and keep the area dry, this seemed to help the healing process better.

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Rh999 said on 07 August 2012

My daughter suffered from this for a year and it then worsened by the spots becoming infected and another rash developed. We did need antibiotics to treat the rash, and we were increasingly frustrated by letting the disease run its course as recommended and started searching the internet. This if full of scare stories however we did find this 2012 research in a medical journal which recommended tee tree oil in the bath and then an iodine spray for the spots after a bath. The results have been amazing and we are now down to one spot after a couple of weeks! Iodine spray can be purchased from a pharmacist. According to the article, tee tree oil by itself was ineffective. Hope this helps!

http://jddonline.com/articles/dermatology/1751

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jsg58 said on 20 June 2012

My 6 year old daughter developed this in Sep 2011 and although she only had 3 or 4 spots each one would become quite large bumpy and sensitive and then red/infected in the skin around it. The doctor could only recommend steroid cream to prevent the skin from becoming dry, which would limit scratching, but this did not help the infection.

By April 2012, she probably had 60-70 spots, many of which were red and sore, mainly on her legs and stomach and the situation was worsening. We often had to put plasters over the ones that rubbed on her clothes.

I tried the treatments recommended by hcs (May 2011) but because we live in New Zealand I couldn't get hold of everything. So, we started with Dettol, which we dabbed on with cotton wool, then Silver solution, then Sudocrem on the white spots and Crystacide on the infected spots. Crystacide is an over the counter first aid cream available here which is lipid stabilised hydrogen peroxide 1% w/w.

This was a lengthy process and my daughter found it very hard to stay still, but after a couple of weeks she was used to it, and it became part of her bed time routine.

After about 3 weeks we were just using the dettol and first aid cream as it had become apparent that she wasn't getting any new spots and the ones she had were all improving.

It seems that each spot has to go through all it's stages (getting larger, the white disappearing, becoming red and slowly fading) which can't really be speeded up. However, keeping them clean with the Dettol has stopped them from spreading and I intend to use this until they have all completely disappeared. We don't need the first aid cream now as none are infected.

I am very grateful to hcs because I was in despair- there just didn't seem to be anything I could do to help. If the doctor had told me that keeping them really clean would have stopped the spots from spreading, my daughter would not have had so much discomfort. It's such a simple thing to do.

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jsg58 said on 20 June 2012

My 6 year old daughter developed this in Sep 2011 and although she only had 3 or 4 spots each one would become quite large bumpy and sensitive and then red/infected in the skin around it. The doctor could only recommend steroid cream to prevent the skin from becoming dry, which would limit scratching, but this did not help the infection.

By April 2012, she probably had 60-70 spots, many of which were red and sore, mainly on her legs and stomach and the situation was worsening. We often had to put plasters over the ones that rubbed on her clothes.

I tried the treatments recommended by hcs (May 2011) but because we live in New Zealand I couldn't get hold of everything. So, we started with Dettol, which we dabbed on with cotton wool, then Silver solution, then Sudocrem on the white spots and Crystacide on the infected spots. Crystacide is an over the counter first aid cream available here which is lipid stabilised hydrogen peroxide 1% w/w.

This was a lengthy process and my daughter found it very hard to stay still, but after a couple of weeks she was used to it, and it became part of her bed time routine.

After about 3 weeks we were just using the dettol and first aid cream as it had become apparent that she wasn't getting any new spots and the ones she had were all improving.

It seems that each spot has to go through all it's stages (getting larger, the white disappearing, becoming red and slowly fading) which can't really be speeded up. However, keeping them clean with the Dettol has stopped them from spreading and I intend to use this until they have all completely disappeared. We don't need the first aid cream now as none are infected.

I am very grateful to hcs because I was in despair- there just didn't seem to be anything I could do to help. If the doctor had told me that keeping them really clean would have stopped the spots from spreading, my daughter would not have had so much discomfort. It's such a simple thing to do.

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bea90 said on 08 June 2012

As the previous comments suggest I would also strongly advise against squeezing the spots.

I had this virus when I was about 7 years old, (now 22) and I still vividly remember the pain it caused! I had the spots on my face, neck and hands. The doctor at the hospital picked at them with a cocktail stick which was very painful. After that they bled. One of the spots on my neck got infected after and was most unpleasant. Gooey and scabby and as an active child I knocked the scab off it quite a lot. I now have a deep scar where it was and another smaller one under my nose.

My mother always told me she wished she never brought me to the hospital! So I could imagine she was quite distressed about it all! If your are a parent and your child has this virus please use alternative treatments, or if it is not bothersome, let it go of its own accord!

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Sam 1969 said on 15 April 2012

This advice is simply misleading - I would not recommend that anyone squeezes MC - They will spead, may scar and cause unsightly blemishes. NHS Choices - You need to change this advice Although the second paragraph says go and see your GP first this is a poor defence as Patients/parents are looking on here because they want an alternative to seeing their GP... please change this advice

I have had two children with MC - Both were approx 2-3 years duration. It is a very distressing condition (but to be honest mainly for the parents) My daughters 4 and 6 coped with the brilliantly - We just called them 'spots' We tried all sorts but settled on Tea Tree oil when they became inflamed, Silver spray over them (but not sure if this worked) and children probiotics and vitamins. Trying to build their immune system. They do go eventually just support your children during the time.

We still went swimming but wore long sleeved tops.

Parents stay strong for your children these do look terrible, my daughter had between 60-80 plus all under and down her arms and others over her body with approx 5 on her neck and a couple on her face. The are all now going, it just takes time. (I as a parent was very distressed - my daughter just matter of fact)

Finally, please don't squeeze - this is simply very poor advice they are so infectious that they will spead.

NHS CHOICES please review this advice..... Its misleading - squeezing the spots is not the answer

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hcs said on 24 May 2011

My 9 year old daughter has had a significant case of this for two months and it was spreading, GP advice was to squeeze which i did not agree with. Having read this and other online sources I have treated it in with a variety of alternative remedies and it has virtualy gone in two weeks of treatment leaving only slight red marks but no scarring where the lesions were.
I used a combination of direct topical application of TCP and 11% liquid salicylic acid (Scholl callous and corn removal treatment) onto the central core surface of the lesions avoiding surrounding skin. Allowed this to dry, then spray with colloidal silver solution across the entire affected areas ( neck, armpit and tummy), allowed to dry and then plastered with Sudocreme directly over the lesions. This done every evening after bathing. In parallel oral supplement of a betaglucan (am empty stomach) and concentrated olive leaf extract (pm with food). Positive results within one week, 99% clear after two weeks. Also using the collidal silver spray in all other areas to protect against reinfection.

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dannhs said on 14 July 2009

Since reading this article I've been squeezing them and cleaning up afterwards, keeping clean etc and I think they've spread since!!
So I've just been to buy some cream with 10% Benzoyl Peroxide but they wouldn't give me any more than 5% so I'm going to try this. PanOxyl Cream 5 it's called.
Never had this before but it really doesn't look good at all! :-(

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pottsy62 said on 13 July 2009

I would be very wary about following the advice of squeezing the mollusca as the first and most simple type of treatment for molluscum contagiosum.

We followed this advice when it was given at our local drop-in centre but unfortunately the spot became infected and turned into an abscess. Two courses of antibiotics have not shifted the abscess and our 5 year old not faces an operation under a general anesthetic to remove the abscess. All because of simple spots that were not really affecting her.

On returning to the drop in another practitioner told us that they should not have recommended squeezing the spots and they believe that the advice on NHS Direct is wrong..

If it doesn’t affect the child and they will go away of its own accord, our advice would to leave it alone, don’t follow the advice above.

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