Expert Panel Proposes Practical Treatment Algorithm for Pediatric Molluscum Contagiosum
Key Takeaways
- An expert-developed algorithm emphasizes disease burden, lesion count, comorbidities, and shared decision-making when treating pediatric molluscum contagiosum.
- The panel identified FDA-approved berdazimer 10.3% gel (ages 1 year and older) and cantharidin 0.7% solution (ages 2 years and older) as treatment options across severity levels.
- Watchful waiting remains an option, but the panel generally discourages routine observation alone for moderate-to-severe disease.
A pediatric dermatology expert panel has proposed a practical treatment algorithm for molluscum contagiosum that emphasizes disease severity, family preferences, and shared decision-making. Presented in a 2026 Fall Clinical Dermatology Conference poster, the framework addresses a common, transmissible viral skin condition that may persist for months or years despite its often self-limited course.
Nanette B. Silverberg, MD, FAAD, FAAP, and colleagues developed the consensus-based approach after reviewing evidence on transmission, disease burden, and available treatments, including approved and off-label medications and procedures. The authors described the algorithm as clinical guidance rather than a formal practice guideline.
Treatment Choices Based on Disease Burden
The framework broadly categorizes mild disease as fewer than 10 lesions with few or no symptoms and moderate-to-severe disease as 10 or more lesions or symptomatic disease. These thresholds are approximate; lesion distribution, atopic dermatitis, immunodeficiencies, family circumstances, and quality-of-life effects also inform decisions.
The panel identified two US Food and Drug Administration–approved options: clinician-applied cantharidin 0.7% solution (Ycanth), indicated for patients aged 2 years or older, and patient- or caregiver-applied berdazimer 10.3% gel (Zelsuvmi), indicated for patients aged 1 year or older. The poster reports complete clearance rates of 46% to 54% with cantharidin versus 13% to 18% with vehicle by day 84 in pooled phase 3 trials, and approximately 30% to 32% with berdazimer versus 20% with vehicle by week 12 in integrated analyses. These figures derive from separate studies and are not a head-to-head comparison.
Cryotherapy and curettage may be considered in selected children able to tolerate procedures. Counseling includes avoiding shared towels and co-bathing, addressing associated atopic dermatitis, and discussing treatment expectations. Although observation remains an option, the panel generally discourages routine watchful waiting in moderate-to-severe disease because of its potential burden and spread.
The authors note that the algorithm is not exhaustive and centers on practical treatment choices for children.
- Silverberg NB, Benjamin L, Gonzalez ME, et al. A practical algorithm for the treatment of molluscum contagiosum: clinical guidance based on current evidence and expert consensus. Poster presented at: Fall Clinical 2026. Poster supplied by user; presentation date and venue not specified on poster.