Systematic Review Highlights Comparative Outcomes Across Molluscum Contagiosum Therapies
Key Takeaways
- A systematic review of 89 studies involving nearly 13,000 patients found curettage, potassium hydroxide (KOH), autoinoculation, and podophyllotoxin achieved the highest clearance rates for molluscum contagiosum (MC).
- Newly approved agents, including cantharidin and berdazimer gel, demonstrated favorable safety and tolerability profiles, particularly in pediatric populations.
- Immunotherapies and laser-based approaches may offer benefit in refractory or recurrent MC, though additional standardized trials are needed.
A new systematic review evaluating treatments for molluscum contagiosum (MC) found that curettage, potassium hydroxide (KOH), autoinoculation, and podophyllotoxin demonstrated some of the highest lesion clearance rates among currently available therapies, while newer agents such as berdazimer gel may provide well-tolerated options for pediatric patients.
The review, conducted according to PRISMA guidelines and published in Journal der Deutschen Dermatologischen Gesellschaft, analyzed 89 studies encompassing 12,955 participants with MC. Approximately 69% of included studies focused on pediatric populations, with a weighted mean patient age of 7 years.1
Among the therapies reviewed, curettage achieved a reported clearance rate of 97.8%, while autoinoculation, KOH, and podophyllotoxin demonstrated clearance rates of 79.4%, 73.8%, and 75.0%, respectively. Laser-based therapies, including pulsed dye laser and carbon dioxide laser, were associated with rapid lesion resolution, although discomfort and cost may limit broader use.
The authors also evaluated newer US Food and Drug Administration (FDA)-approved and emerging therapies. Cantharidin, approved by the FDA in 2023 for MC, showed complete response rates ranging from 46.3% to 54% in pooled phase 3 trial analyses. Berdazimer gel, a nitric oxide–releasing topical therapy approved in 2024, demonstrated lesion reductions ranging from 51.7% to 76% over 12 weeks with generally mild application-site adverse events.
Intralesional immunotherapies, including Candida antigen and measles-mumps-rubella (MMR) vaccine, showed encouraging efficacy in persistent or recurrent disease, particularly among immunocompetent patients.
Most adverse events across treatment categories were localized and transient, including pain, blistering, erythema, pigmentary alteration, and irritation. The investigators noted substantial heterogeneity among included studies, including differences in outcome reporting, treatment protocols, and follow-up duration.
“Ultimately, treatment selection needs to be individualized," the authors wrote, "and must balance efficacy, tolerability, lesion burden, and access to care.”
- Wang OJE, Shergill M, Aldien AS, Mukovozov I. Treatments for molluscum contagiosum: A systematic review. J Dtsch Dermatol Ges. Published online 2025. doi:10.1111/ddg.70100