Guideline sources The following summarized guidelines for the management of molluscum contagiosum are prepared by our editorial team based on guidelines from the British Association for Sexual Health and HIV (BASHH 2022) and the European Academy of Dermatology and Venereology (EADV 2021). 1 2 Guidelines 1. Medical management Expectant management: As per BASHH 2022 guidelines, offer expectant management in immunocompetent patients with genital molluscum contagiosum. B As per EADV 2021 guidelines, avoid offering treatment for genital molluscum contagiosum and wait for spontaneous resolution in immunocompetent patients, however recognizing that many patients with sexually transmitted lesions would request treatment. D Topical agents: As per BASHH 2022 guidelines, consider offering podophyllotoxin 0.5% in immunocompetent patients with genital molluscum contagiosum. C Show 3 more As per EADV 2021 guidelines, consider offering patient-applied podophyllotoxin applied to genital lesions BID for 3 consecutive days with a break for 4 days, repeated as necessary until https://web.pathway.md/diseases/recx5c7Aj5RLkmBbz 1/3 6/30/23, 1:05 AM Molluscum contagiosum Pathway clearance. B Show 3 more Systemic agents: Insufficient evidence to support the use of systemic treatments aimed at stimulating immune response to the molluscum virus, such as systemic interferon and oral cimetidinen. I Insufficient evidence to recommend treatment other than antiretroviral therapy in immunosuppressed patients with genital molluscum contagiosum. I Antiretroviral therapy: initiate antiretroviral therapy in immunosuppressed patients with extensive molluscum contagiosum lesions. B Management of eczema: offer emollients and, if necessary, a topical corticosteroid for the treatment of associated eczema, particularly when itchy, to reduce the risk of molluscum auto- inoculation by scratching. B 2. Therapeutic procedures Cautery: perform cautery (after topical anesthetic) as an easy and quick method for the management of patients with genital molluscum contagiosum. B Curettage: Consider performing curettage of genital molluscum as an alternative to cautery. B Prefer cautery over curettage for genital lesions, because although curettage may eliminate lesions more definitively it is more traumatic and painful. B Cryotherapy: As per BASHH 2022 guidelines: Consider offering liquid nitrogen therapy in immunocompetent patients with genital molluscum contagiosum. C Consider offering liquid nitrogen therapy in human immunodeficiency virus-positive patients with genital molluscum contagiosum. C As per EADV 2021 guidelines, insufficient evidence to recommend cryotherapy in patients with genital molluscum contagiosum, although it is frequently used in sexual health and dermatology centers. I Clinical findings Patient demographics Symptoms Children Itching Past medical history Head and neck exam Atopic dermatitis Oral papules https://web.pathway.md/diseases/recx5c7Aj5RLkmBbz 2/3 6/30/23, 1:05 AM Molluscum contagiosum Pathway Human immunodeficiency virus infection Integument exam Papules with central umbilication Immunocompromising condition Genitourinary exam Perianal papules Skin papules References 1. S Edwards, M J Boffa, M Janier et al. 2020 European guideline on the management of genital molluscum contagiosum. J Eur Acad Dermatol Venereol. 2021 Jan;35 1 17 26. Open 2. Imali Fernando, Sarah K Edwards, Deepa Grover. British Association for Sexual Health and HIV national guideline for the management of Genital Molluscum in adults 2021 . Int J STD AIDS. 2022 Apr;33 5 422 432. Open 3. Imali Fernando, Jill Pritchard, Sarah K Edwards et al. UK national guideline for the management of Genital Molluscum in adults, 2014 Clinical Effectiveness Group, British Association for Sexual Health and HIV. Int J STD AIDS. 2015 Sep;26 10 687 95. Open https://web.pathway.md/diseases/recx5c7Aj5RLkmBbz 3/3