Molluscum contagiosum: The Daily PANCE Blueprint

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Molluscum contagiosum: The Daily PANCE Blueprint

A 28-year-old sexually active male presents to your clinic with a 2-month history of multiple, painless, small, raised lesions on his inner thighs and pubic area. He denies any itching, burning, or discharge. He is otherwise healthy and does not take any medications. On physical examination, you observe approximately 15 discrete, 2-4 mm, flesh-colored, dome-shaped papules with central umbilication. Some of the lesions appear to be excoriated. He is concerned about the appearance of the lesions and requests treatment. He has no known drug allergies. Which of the following is the most appropriate initial treatment for this patient's condition?

A. Oral acyclovir
B. Topical imiquimod 5% cream
C. Topical mupirocin 2% ointment
D. Oral griseofulvin
E. Intralesional interferon-alpha

Answer and topic summary

The answer is B. Topical imiquimod 5% cream

The patient’s clinical presentation is consistent with molluscum contagiosum (MC), a common viral skin infection caused by a poxvirus. The characteristic lesions are small, flesh-colored, dome-shaped papules with central umbilication. Imiquimod is an immunomodulatory agent that induces local cytokine production, leading to an antiviral and antitumor response. It has been shown to be effective in treating MC, although it may take several weeks to see improvement. Topical imiquimod is often preferred as a first-line treatment for MC in adults, especially when lesions are numerous or in cosmetically sensitive areas, because it is non-invasive and can be self-administered. Other treatment options include cryotherapy, curettage, and topical cantharidin, but these may be more painful or cause scarring.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Dermatology ⇒ Viral Dermatologic Diseases (PEARLS) ⇒ Molluscum contagiosum

Also covered as part of the Family Medicine Rotation PAEA EOR topic list

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