Treatment of Molluscum Contagiosum in Adults

Clinical Presentation and Diagnosis

Molluscum contagiosum presents as characteristic skin-colored, whitish, or pink papules with a shiny surface and central umbilication, caused by a poxvirus and transmitted through direct skin contact, fomites, or self-inoculation 1, 2
Lesions typically persist for 6 months to 5 years without treatment, and in adults, large and multiple molluscum lesions with relatively little conjunctival inflammation may indicate an immunocompromised state 1, 3

Incision and curettage is recommended as an effective physical removal method, and simple excision or excision and cautery are equally effective first-line options, according to the American Academy of Ophthalmology 3, 1
Cryotherapy with liquid nitrogen is another recommended first-line treatment, and when treating, identify and address all lesions, including nascent ones, to reduce the risk of recurrence 1, 3

For lesions on or near eyelids with associated conjunctivitis, removal of the lesion is indicated, and the conjunctivitis may require weeks to resolve after elimination of the lesion, as suggested by the American Academy of Ophthalmology 3

Confirm diagnosis based on characteristic appearance of lesions, and assess extent of disease and presence of complications such as associated conjunctivitis 1, 2, 3
For limited disease in immunocompetent adults, proceed with physical removal methods, and for extensive disease or in immunocompromised patients, consider referral to dermatology 3, 1
Follow-up is not usually necessary unless conjunctivitis persists or new lesions develop, according to the American Academy of Ophthalmology 3, 1

Reducing viral load through treatment often allows the host immune response to eliminate residual virus 1
Multiple large lesions with minimal inflammation should prompt consideration of an immunocompromised state, as suggested by the American Academy of Ophthalmology 3