Many treatment options from which to choose
MC is usually self-limiting, although it can take several months—or even a few years—to resolve on its own6 (strength of recommendation [SOR]: B). However, most patients with MC should receive treatment to obtain relief from symptoms, prevent autoinoculation or transmission to close contacts, decrease occurrence of scarring, reduce secondary bacterial infections, and improve cosmesis.
Several treatment options are available, and most rely on destruction of the lesions. Manual extrusion is a simple but effective therapy6 (SOR: B). Cryotherapy and curettage are also effective treatment options5 (SOR: C). Pretreatment topical anesthesia is often helpful if these therapies are used in children.
Topical imiquimod2 (1%-5%) cream applied 3 to 7 times a week can be used to treat generalized MC infection or MC localized to the anogenital area6 (SOR: A). Some patients may improve with topical tretinoin therapy6 (SOR: C).
Chemical cauterization with 10% povidone iodine with 50% salicylic acid7 (SOR: B), 10% potassium hydroxide8 (SOR: B), cantharidin2 (SOR: C), or 25% to 50% trichloroacetic acid6 (SOR: C) is also effective. Treatment with flashlamp pulsed dye laser is a safe and efficient treatment modality9 (SOR: C). Cidofovir10 (1%-3%) cream or ointment, electron beam therapy, and photodynamic therapy have also been used with variable success rates6 (SOR: C).
MC is particularly difficult to treat in patients with poorly managed HIV and AIDS. Pairing proper antiretroviral therapy with lesion-destroying therapies is usually helpful for these patients.3
If you are caring for a patient with giant MC, you’ll need to stress the benign—but potentially contagious—nature of the disease. Tell the patient to wash his or her hands frequently, to avoid scratching the lesions, and to keep infected areas covered with clothing (when possible). In suspected sexually transmitted cases, the patient should adopt safe sexual practices or abstinence, if necessary. It is unclear whether condoms or other barrier methods provide adequate protection.1
Our patient transfers to the HIV clinic
We sequentially expressed the large lesions on our patient’s face and put her on a course of cefadroxil to control the secondary infection of MC. Her facial lesions gradually improved over 2 months.
We also referred the patient to our institution’s HIV clinic, where she was put on highly active antiretroviral therapy (HAART). We advised her mother to get tested for HIV, and she turned out to be HIV positive, as well.
CORRESPONDENCE Sudip Kumar Ghosh, MD, DNB, Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, 1 Khudiram Bose Sarani, Kolkata-700004, West Bengal, India; dr_skghosh@yahoo.co.in