Molluscum contagiosum is a benign viral skin disease occurring worldwide that commonly affects children. Spread may occur by autoinoculation or direct contact or via fomites. 1 In immunocompetent individuals each lesion may last 6-8 weeks. With continuous autoinoculation, however, new lesions appear over time, such that the mean duration is about 8 months, 2 with reports of infection lasting up to five years.3 Although resolution is ultimately spontaneous, scarring may occur, particularly if the lesions are secondarily infected. Thus there may be justification for active intervention in the hope of speeding resolution and hence limiting scarring, transmission, and the period of social exclusion. Although many treatments are cited in the literature with destruction of the lesions as their common goal, 4 5 a systematic review has revealed little good trial evidence to support them (RMMacS, unpublished observations). We compared the efficacy and cosmetic results of two commonly cited treatments: physical expression by squeezing and chemical ablation with phenol.
Participants, methods, and resultsFourteen (7 male) of 16 patients referred to a paediatric dermatology clinic with at least four molluscum contagiosum lesions entered the trial under parental consent. The average age was 4.6 years (range 7 months to 12 years), and 108 lesions (mean 7.7 (SD 5.0); range 3-16) were studied. Lesions on each patient were photographed and stratified by size, and alternate, similar sized lesions were either treated by physical expression with gloved fingers (52/108) or were pierced with a sharpened orange stick impregnated with phenol. Emla cream (Astra, Kings Langley, Hertfordshire), applied one hour previously, provided effective analgesia, and subsequent procedures were well tolerated. One month after treatment, the participants were reviewed by a single observer, and the treated lesions were graded for resolution (unresolved, partial, or complete) and scarring (none, pitting < 1 mm depth, pitting ≥ 1 mm depth). Outcome was also dichotomised to contrast (a) complete resolution with no or partial resolution and (b) any degree of scarring with none. Odds ratios, controlling for clustering within participant, were derived from two level, generalised linear mixed models of each binary outcome.Overall, 76% (82/108) of lesions completely resolved, while only 11% (12/108) exhibited no discernible response. The table presents frequency of resolution and scarring scores by treatment method. No significant differences were observed for either crude resolution scores (P = 0.33) or as a dichotomous outcome when participant effect was controlled for (odds ratio 0.93; 95% confidence interval 0.35 to 2.44, P = 0.89). However, 63% (35/56) of lesions treated by physical expression showed no scarring, compared with only 19% (10/52) of those treated with phenol (P < 0.001). When participant effect and lesion resolution were controlled for, the unadjusted odds ratio (phenol ablation v physical expression) for the development of any scarring inc...