Autoinoculation vs 35% Trichloroacetic Acid for Molluscum Contagiosum Journal of the American Academy of Dermatology

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• In this randomized controlled study, 124 patients with 5 or more non-genital lesions, clinically diagnosed as molluscum contagiosum, were treated with either a single session of 35% trichloroacetic acid (TCA) or autoinoculation. Autoinoculation was performed by repeatedly piercing a well-formed lesion with an insulin syringe. At 3 months, complete clearance was achieved in 80% of the autoinoculation group compared with 62% of the TCA group. Recurrence at 6 months was lower in the autoinoculation group compared with that in the TCA group (3% vs 40%).

• Autoinoculation is an effective treatment for molluscum contagiosum.

–  Katherine M. Stiff, MD

Written by

 

 

Ashish C. Bhatia MD, FAAD 

Written by

 

Eliot N. Mostow MD, MPH 

Written by

 

 

Robert T.Brodell MD, FAAD

This small study is important because it speaks of doing less to get an equal to better benefit with no significant side effects! There has been debates for years about whether we should treat these lesions, but I support doing something, rather than letting a child end up with hundreds of lesions (and spreading the lesions to other children as well). This simple idea of "auto inoculation" is puncturing the perilesional and lesional skin five to seven times with a needle from an insulin syringe. Presumably, this puts some of the molluscum virus into the dermis, so that the immune system can finally recognize the virus, which is the reason for the ultimate clearance. 

We like simple solutions and would like to keep this idea in our treatment regimen as we await more robust studies.  

Abstract

Despite the availability of numerous destructive or immunomodulatory treatment options for molluscum contagiosum (MC), a single universally reliable and effective therapeutic modality is yet to emerge. Autoinoculation is a well-studied treatment modality for warts. Recently Kachhawa et al demonstrated that autoinoculation is a successful treatment modality for MC, which helped in clearance of both local and distant lesions. This prompted us to compare the efficacy of autoinoculation versus tricholoroacetic acid (TCA) in MC.

Journal of the American Academy of Dermatology

A randomized controlled pilot study of autoinoculation versus 35% trichloroacetic acid for the treatment of molluscum contagiosum

J Am Acad Dermatol 2022 Mar 15;[EPub Ahead of Print], D Kachhawa, P Choudhary, S Saraswat, A Lamoria, YR Joshi, C Yadav 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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