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  • • Parent’s or child’s desire for office-based treatment.

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Absolute

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  • • Molluscum in facial, genital, or perianal area.

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Relative

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  • • Previous cantharidin application with severe blistering.

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  • • Cantharidin 0.9% in flexible collodion.

    • Blunt-ended wooden applicator.

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  • • Pain.

    • Blistering.

    • Secondary infection.

    • Temporary hyperpigmentation or hypopigmentation.

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  • • Inflamed lesions should not be treated because they are resolving spontaneously.

    • If inflamed lesions are treated, they may blister more severely than uninflamed lesions.

    • Excoriated lesions do not need treatment. The central molluscum body has likely been mechanically removed.

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  • • Patient and parent education is crucial for a successful relationship with families of children with molluscum.

    • Although molluscum contagiosum is a self-resolving infection, parents may demand treatment.

    • If a physician defers treatment of a few molluscum and numerous lesions later develop, the parents may “blame” this often unpreventable spread on the physician.

    • Treatment does not prevent transmission or the development of new lesions.

    • An initial trial of treatment of a few lesions may be helpful in demonstrating the sequelae of therapy.

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  • • The patient should be comfortable and hold still for this therapy because moving may cause cantharidin to be applied in unintended locations and blistering may result.

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  • • Apply a small amount of cantharidin to the applicator and transfer this to the molluscum lesion (Figure 37–1).

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  • • Minimize contact with surrounding normal skin.

    • Ensure complete drying before the patient moves or dresses.

    • Treat a maximum of 20–30 lesions per visit.

    • Have the child bathe 4–6 hours after application.

    • • The treated areas can be washed with a soft washcloth and mild soap.

      • If child experiences blistering, discomfort, or burning within the first 4 hours, the areas should be gently washed sooner.

      • Scrubbing of treated areas is not necessary and should be discouraged.

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Figure 37–1.
Graphic Jump Location

Treating a molluscum lesion with cantharidin on applicator.

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  • • The blister that occurs with cantharidin therapy may be painful.

    • • Apply antibiotic ointment to the areas twice daily until the blisters resolve.

      • Acetaminophen or ibuprofen can be given for pain.

    • Scarring, hyperpigmentation or hypopigmentation, and secondary bacterial infection may occur.

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  • • Follow-up is suggested in 2–4 weeks to treat new lesions.

Silverberg NB, Sidbury R, Mancini AJ. Childhood molluscum contagiosum: experience with cantharidin therapy in 300 patients. J Am Acad Dermatol. 2000;43:503–507.  [PubMed: 10954663]

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