Recent advances in the treatment of molluscum contagiosum

Molluscum contagiosum (MC) is a common, benign, viral skin infection caused by the MC virus (MCV), a member of the Poxviridae family.¹ It manifests as small, raised, dome-shaped papules with central umbilication. MC affects approximately 6 million individuals in the US annually, with the highest incidence among those younger than 14 years.² Transmission primarily occurs through direct contact with infected individuals or through sharing infected materials, including clothing, towels, toys, and pool equipment.³

Natural course and transmission prevention

Health care providers often take a noninterventional approach known as “benign neglect,” allowing the infection to resolve on its own.⁴ A retrospective study found that MC persists on average approximately 9.9 months in untreated individuals without immunodeficiencies, with about 77% of participants reporting no sequelae.⁵ Although MC can be left untreated, it can cause psychosocial distress due to skin irritation, visibility of lesions, and fear of infecting others. In fact, MC is transmitted to other children in the household in approximately 40% of cases.⁶ Infection may be prevented by covering lesions with clothing or a bandage, washing hands thoroughly after touching bumps, and avoiding sharing contaminated items.

Traditional treatment approaches

Treatment of MC previously focused on mechanical removal in the form of curettage, cautery, laser therapy, or cryotherapy, which can cause pain, bleeding, and scarring.⁷ Other categories of treatment include chemical, immunomodulatory, and
antiviral methods.

Recent FDA-approved treatments

There has been a recent shift toward FDA-approved therapies for MC. Cantharidin topical solution, 0.7% (Ycanth; Verrica Pharmaceuticals Inc) was approved in July 2023 and must be administered in-office by a clinician. And in January 2024, berdazimer topical gel, 10.3% (Zelsuvmi; LNHC, Inc) became the first FDA-approved at-home treatment for MC.

Cantharidin

Mechanism of action and background

Cantharidin is a vesicant and keratolytic agent that activates neutral serine/threonine proteases to cause intraepidermal blistering and acantholysis.⁸ Cantharidin is produced by beetles of the Coleoptera order and Meloidae family, commonly known as blister beetles or Spanish fly. It is a long-standing remedy in traditional Chinese medicine and in folk medicine from Europe, Africa, and other parts of Asia used to treat a variety of ailments, from ulcers and furuncles to rabies, cancer, and
abdominal masses.⁹

Regulatory history

Dermatologists have treated MC and warts with cantharidin since the 1950s. However, the FDA removed cantharidin from the market in 1962 when no efficacy data were submitted in compliance with the Drug Efficacy Study Implementation program under the Food, Drug, and Cosmetic Act. It was then added to the FDA’s bulk substances list in 1998, which permitted pharmacy compounding of cantharidin and topical application by a physician or pharmacist.⁸

Clinical trial evidence

The approval of cantharidin 0.7% was based on findings from 2 identical phase 3 randomized, vehicle-controlled, double-blind clinical trials, CAMP-1 (NCT03377790) and CAMP-2 (NCT03377803), conducted in
2018 with a total of 528 participants. VP-102, the drug-device combination containing cantharidin, 0.7% (weight/volume), was administered every 21 days for a maximum of four treatments. This resulted in complete lesion clearance rates of 46.3% and 54.0% vs 18% and 13% with the vehicle in CAMP-1 and CAMP-2, respectively. Mild to moderate adverse effects (AEs) were reported by the majority of participants in the treatment groups, including application-site vesicles, pain, pruritus, erythema, and scabs.¹⁰

Berdazimer

Mechanism of action and background

Berdazimer is a topical nitric oxide (NO)–releasing agent, a class of drugs studied in dermatology for its immunomodulatory and antimicrobial properties. At high concentrations, NO is oxidized and inhibits molecular pathways involved in MC viral replication.¹¹ This was first investigated in 1999 in a clinical trial, which reported a 75% cure rate for MC in the group treated with topical acidified nitrite vs 21% in the control treatment group.¹² Several AEs were noted, including skin discoloration and irritation, but this did not prevent
successful treatment.¹²

Clinical trial evidence

Berdazimer gel 10.3% is the first novel drug for the treatment of MC and the only topical prescription medication for MC approved for application outside a medical office, offering a convenient option for families to treat MC safely at home. It was approved after the phase 3 multicenter, vehicle-controlled, double-blind, randomized B-SIMPLE4 clinical trial (NCT04535531) conducted between 2020 and 2021 with 891 participants. Berdazimer gel 10.3% or the vehicle gel was applied as a thin layer to all lesions once daily for 12 weeks. At week 12, 32.4% in the berdazimer group achieved complete clearance of MC lesions vs 19.7% in the vehicle group. AE rates were low, with the most common being application-site pain and mild to moderate erythema.²

Emerging therapies: Immunotherapy

Additionally, recent studies have investigated the effectiveness of intralesional injections of various antigens to combat cutaneous viruses through stimulating cell-mediated immunity.¹³ One study compared intralesional injections of the measles-mumps-rubella (MMR) vaccine with tuberculin purified protein derivative (PPD) antigens for MC in 30 participants. A statistically significant clearance of MC in the MMR- and PPD-treated groups was found vs those given saline, although there was no significant difference between the MMR- and PPD-treated groups themselves.¹⁴ Similar results were reported when comparing intralesional
Candida antigen vs varicella-zoster vaccine in a group of 48 patients.¹⁵ These interventions are promising options for clearing resistant MC with
minimal AEs.^14,15

Conclusion

Significant advancements have been made in the development of noninvasive treatments for MC, particularly with the FDA approval of cantharidin and berdazimer, offering alternatives to mechanical removal and benign neglect (Table^16,17). Emerging immunotherapies further expand the therapeutic landscape, especially for patients with refractory MC. Continued research is essential to improve patients outcomes, particularly children who may experience discomfort and social stigma associated with the
skin disease.

References

1. Ulrych JM, Krupa J, Malinowski M, et al. Molluscum contagiosum: a comprehensive review of treatment modalities. Wiad Lek. 2025;(7):1418-1425. doi:10.36740/WLek/206905

​​2. Browning JC, Enloe C, Cartwright M, et al. Efficacy and safety of topical nitric oxide−releasing berdazimer gel in patients with molluscum contagiosum: a phase 3 randomized clinical trial. ​JAMA Dermatol. 2022;158(8):871-878. doi:10.1001/jamadermatol.2022.2721

3. CDC. About molluscum contagiosum. November 20, 2025. Accessed May 1, 2026. https://www.cdc.gov/molluscum-contagiosum/about/index.html

4. Hebert AA, Bhatia N, Del Rosso JQ. Molluscum contagiosum: epidemiology, considerations, treatment options, and therapeutic gaps. J Clin Aesthet Dermatol. 2023;16(8, suppl 1):S4-S11.

5. Yi RC, Razler D, Agner ML, et al. Duration of persistence of molluscum contagiosum: a retrospective study. JAAD Int. 2025;21:3-4. doi:10.1016/j.jdin.2025.02.004

6. Olsen JR, Gallacher J, Finlay AY, Piguet V, Francis NA. Time to resolution and effect on quality of life of molluscum contagiosum in children in the UK: a prospective community cohort study.Lancet Infect Dis. 2015;15(2):190-195. doi:10.1016/S1473-3099(14)71053-9

7. Meza-Romero R, Navarrete-Dechent C, Downey C. Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clin Cosmet Investig Dermatol. 2019;12:373-381. doi:10.2147/CCID.S187224

8. Moed L, Shwayder TA, Chang MW. Cantharidin revisited: a blistering defense of an ancient medicine. Arch Dermatol. 2001;137(10):1357-1360. doi:10.1001/archderm.137.10.1357

9. Ghali H, Smith LR, Krenitsky A, et al. Topical cantharidin use in dermatology: an updated review. Dermatol Online J. 2025;30(6). doi:10.5070/D330664680

10. Eichenfield LF, McFalda W, Brabec B, et al. Safety and efficacy of VP-102, a proprietary, drug-device combination product containing cantharidin, 0.7% (w/v), in children and adults with molluscum contagiosum: two phase 3 randomized clinical trials. JAMA Dermatol. 2020;156(12):1315-1323. doi:10.1001/jamadermatol.2020.3238

11. Singh A, Lohana N, Shaikh S, Nazir Z, Mandhan V, Haque MA. Zelsuvmi: a novel approach to treating molluscum contagiosum. Ann Med Surg (Lond). 2025;87(5):2524-2525. doi:10.1097/MS9.0000000000002939

12. Ormerod A, White MI, Shah SA, Benjamin N. Molluscum contagiosum effectively treated with a topical acidified nitrite, nitric oxide liberating cream. Br J Dermatol. 1999;141(6):1051-1053. doi:10.1046/j.1365-2133.1999.03204.x

13. Wells A, Saikaly SK, Schoch JJ. Intralesional immunotherapy for molluscum contagiosum: a review. Dermatol Ther. 2020;33(6):e14386. doi:10.1111/dth.14386

14. Zaky MS, Atallah RB, Mohyeldeen AMS, Elsaie ML. Intralesional injection of tuberculin purified protein derivative (PPD) versus measles, mumps, and rubella (MMR) vaccine in treatment of molluscum contagiosum: a comparative study. Sci Rep. 2024;14(1):288. doi:10.1038/s41598-023-49182-2

15. Elradi M, Hoseiny HAM, Marei A, Boghdadi G, Hosny D. Intralesional candida antigen versus intralesional varicella zoster vaccine in treatment of molluscum contagiosum: a new promising alternative. J Dermatol. 2025;52(5):855-859. doi:10.1111/1346-8138.17660

16. Ycanth. Prescribing information. Verrica Pharmaceuticals Inc; 2024. Published online 2023. Accessed March 8, 2026. https://ycanthpro.com/pdf/Ycanth-Master-PI_112624.pdf

17. Zelsuvmi. Prescribing information. LNHC Inc; 2024. Accessed March 8, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/217424s000lbl.pdf