Information for HCP’s

Molluscum contagiosum is a benign viral infection that is caused by a pox virus (molluscum contagiosum virus). The result of the infection is usually a mild skin disease characterised by lesions (growths) that may appear anywhere on the body. Molluscum contagiosum mostly affects children and young adults but it can affect people of any age. It is estimated that the incubation period is between 2 weeks and 6 months¹. A large UK general-practice survey reported that the annual incidence of cases of molluscum contagiosum in children under 15 was 1,265 per 100,000, with a maximum incidence in pre-schoolers aged 1-4 years².

The lesions average 2mm – 5mm in size and are usually painless but may become itchy, inflamed, red and swollen. The papules are usually small, raised and usually white, pink or flesh-coloured with a central depression. When the core is expressed it produces a white, cheesy material. The patient does not usually experience systemic symptoms, such as fever, nausea, or malaise¹.

Parents may report recent exposure to other children affected with molluscum contagiosum at school, sharing toys or public facilities such as swimming pools. Adults can acquire molluscum contagiosum as an STI through sexual contact.

Molluscum contagiosum lesions can be classified in 1 of 3 ways¹:

1. The commonly-seen skin lesions found largely on the faces, trunks, and limbs of children.
2. The sexually transmitted lesions found on the abdomen, inner thighs and genitals of sexually active adults.
3. The diffuse and recalcitrant eruptions of patients with AIDS or other immunosuppressive disorders.

Molluscum contagiosum is a self-limiting infection which typically resolves itself within 12 – 18 months but may take as long as 4 years. However, certain cases can take far longer to resolve, and patients are often highly embarrassed about their condition².

Diagnosing molluscum contagiosum

Diagnosis is predominately clinical on the basis of characteristic lesions (presenting as smooth-faced, firm, dome-shaped papules with central umbilication). A biopsy is occasionally taken when diagnosing atopic infections².

• MolluDab^® is a clinically proven topical treatment which contains 5% potassium hydroxide and is dabbed onto the bumps twice a day by parents or patients themselves.
• It lyses epidermal cells and after around 4 to 6 days treatment, the immune system mounts an inflammatory reaction to clear the virus. The skin can then commence healing and the molluscum lesions disappear after 1 to 4 weeks, far quicker than leaving the condition to resolve of its own accord.
• In clinical studies the 5% solution is as effective as the 10% potassium hydroxide, but minimised skin irritation associated with the stronger solution³.
• MolluDab^® is ideal for home treatment and is relatively painless than more aggressive treatments³.
• MolluDab^® is suitable for use from 2 years of age.

Classification

MolluDab^® is a CE marked class I medical device.

Composition

1ml MolluDab^® contains 50mg potassium hydroxide. Other ingredient: purified water. 1 package contains 2ml solution for application to the skin. The bottle cap is equipped with a plastic spatula for applying the solution. RRP £24.30

Prescribing information for GPs

MolluDab^® can be prescribed in the UK (apart from Scotland). Patients in the UK can purchase MolluDab^® over the counter in pharmacies or online from Amazon. MolluDab^® should not be used during flare ups of atopic dermatitis or on mucous membranes.

Purchasing information for pharmacists

MolluDab^® can be purchased from wholesalers in the UK using PIP-CODE: 379-5333

The following instructions are a concise guide on how your patients should use MolluDab^®. For a full version, a patient leaflet is also available to download.

1. Before using MolluDab^®

The box can be used as a stand; press in the perforation and place the bottle in the opening to help prevent spillages while using MolluDab^®. Once opened MolluDab^® should be used within 4 weeks.

2. Applying MolluDab^® to the molluscum bumps

Open the child safe lid. The bottle has a protective funnel, when pulling out the spatula excess liquid is stripped off. Dab all the molluscum bumps with the flat side of the spatula. After applying to three – five bumps, wet the spatula with MolluDab^® again. Allow the solution to dry on the bumps. Apply MolluDab^® twice daily (morning and evening).

3. End of use

As soon as inflammation appears (recognisable by redness that lasts for 12 hours or more) stop using the product because it indicates that a molluscum bump is healing.

Stop using MolluDab^® after 14 days, even if no inflammation is apparent and consult your doctor for further advice.

4. Wait for the molluscum lesions to heal

The inflammation indicates that your body is fighting the molluscum bumps. Now it’s time to be patient and wait for the molluscum bumps to heal. Once inflamed, healing usually takes between one and four weeks.

Warnings and precautions

MolluDab^® is well tolerated when used as directed. However, as it contains potassium hydroxide, short-term skin irritation, redness and slight tingling may occur following application but usually subsides after a few minutes. With this in mind MolluDab^® should be used sparingly.

Avoid use on eyes, mucous membranes, open wounds, inflamed molluscum bumps, in infants under two years and immune-compromised individuals. MolluDab^® should not be used during flare ups of atopic dermatitis or on mucous membranes.

Potassium hydroxide efficacy in molluscum contagiosum

• In a letter to the journal Pediatric Dermatology, Romiti et al. (2000)³ published their finding in the treatment of molluscum contagiosum (MC) in children using a topical 10% potassium hydroxide (KOH) aqueous solution. This concentration is the same as that routinely used in skin scrapings to identify fungal elements. Parents were instructed to apply the solution twice a day with a cotton swab to all MC lesions. A stinging sensation was reported by most children during the trial and developed hyper-or hypo pigmentation after treatment at the site of the lesions. In an attempt to reduce those side effects, they carried out a trial using a less concentrated KOH solution. In a new series of 20 children, all MC lesions cleared completely within 6 weeks using a 5% KOH aqueous solution (i.e. MolluDab^®), twice a day. The stinging sensation was absent or minimal during treatment and in no case did they observe disturbances of pigmentation at the end of the study. A 5% KOH aqueous solution (i.e. MolluDab^®) proved to be as effective and less irritating when compared to the 10% KOH solution. This trial also emphasises the effectiveness of topical KOH in the treatment of MC, sparing affected children from more aggressive physical modalities of treatment
• Jansen et al. (2007)4 also conducted a study of 21 children to evaluate the efficacy and tolerability of 5% potassium hydroxide (i.e. MolluDab^®) applied twice daily on each lesion until a clinically visible inflammatory reaction was apparent. The authors confirmed the effectiveness and tolerability of potassium hydroxide with the added benefit of patient and parent compliance and simple application, making it suitable for home treatment.
• Tretinoin: Rajouria et al. (2011)⁵; undertook a study of 50 children comparing 5% potassium hydroxide (i.e. MolluDab^®) with tretinoin treatment, both showed a good response and were well tolerated by the children. However, 5% potassium hydroxide showed faster recovery and most lesions were resolved before end of the four week study period. With tretinoin treatment, the response was slightly more delayed, and some lesions persisted after four weeks.