Molluscum contagiosum is a common skin infection. Most of the practitioners who participated in the survey had dealt with the condition in their practice during the previous year. The bulk of respondents in the survey reported having seen between 1 and 10 cases in the last year. Pediatricians and dermatologists in this survey reported the most experience with MC cases, having seen an average of 11–50 and 51–100 cases, respectively, during the year prior to the survey. The considerable number of cases seen by pediatricians in this survey is consistent with prior reports of elevated MC incidence rates in young children 
Overall, health care providers were most likely to recommend treatment for immunocompromised patients, patients with HIV, adults with genital molluscum, and children with multiple lesions in one area. They were less likely to treat children with one or widely scattered lesions, which coincides with current recommendations (16). In contrast, dermatologists reported a greater readiness to treat MC regardless of the age of the patient or concurrent medical disorders such as HIV or other immunocompromising conditions. A possible explanation for this finding could be that cases are usually referred to a dermatologist by their primary physician specifically for the purpose of treatment. It is also possible that patients who seek care from a dermatologist may be experiencing a less benign manifestation of infection that might require treatment, or they may have lesions that are visible or cause embarrassment. Another explanation might be that dermatologists see so many patients with extensive MC that many believe treatment is worthwhile, even when the patient has minimal lesions. Dermatologists are equipped to routinely remove these types of lesions and therefore may be more inclined to do so.
Cryotherapy and curettage are the top choices for treatment for all health care providers and have been shown to be somewhat effective. However, these techniques can cause scarring, hypo or hyper pigmentation, and can be painful, especially for children 
. Curettage generally requires topical anesthetic. Imiquimod is a popular off-label MC treatment choice of dermatologists, however recent studies have shown it to be ineffective for molluscum and it is currently not approved for treatment of MC in children 
. In addition, there have been case reports of adverse events such as fever, arthralgia, headache, myalgia, lymphadenopathy, febrile seizures and hypopigmentation scars when treating with imiquimod 
. When considering these adverse events, pain, scarring and questionable effectiveness, treatment of such a benign disease may be considered excessive in many cases. However, the consideration of whether or not to treat is likely to be very different for more complicated cases, such as immunocompromised patients. If an effective treatment were available for all MC patients, the cost both financially in terms of doctors’ visits and anxiety could be drastically reduced for both adult patients and child patients and their families.
Most health care providers picked appropriate choices for advice given to MC patients. The top advice from family/general practitioners and pediatricians of “Don’t be concerned, this will go away” is helpful to ease the patient and the patient’s family’s concern about this infection and possibly prevent unnecessary treatment. The top choice for internists, OB/GYNs and dermatologists is “Avoid intimate contact until lesions resolve”. This advice and another top pick, “Avoid touching lesion to reduce further spread”, are effective for preventing spread to others and autoinoculation. Some of the Centers for Diseases Control and Prevention’s (CDC) recommendations () to prevent spread, such as “Wash hands frequently”, “Cover lesion with a bandage or dressing”, “Don’t let others touch patient’s towels/sheets” were chosen infrequently by most health care providers. Dermatologists were more likely to choose these types of recommendations, which could be due to more experience with MC patients compared to other health care providers.
CDC molluscum contagiosum transmission precaution recommendations.
Physicians over the age of 50 were less likely to recommend effective advice such as “Cover lesion with a bandage or dressing”, “Wash hands frequently”, “Avoid touching lesion to reduce further spread”. They were also more likely to offer advice that may be considered ineffective or detrimental, such as “Scratch lesion to promote inflammation and healing”. While there have been claims of scratching as a potential for helping lesions resolve, it is not recommended as it can cause autoinoculation and spread to others. A common query to the CDC hotline made by patients’ families and schools is whether a child with MC should attend school (unpublished data). MC is benign and can take months to resolve, therefore excluding children from school is considered excessive and unnecessary. Very few health care providers picked “Avoid school until the lesions resolve (children)” for advice offered.
Knowledge gaps for appropriate transmission precaution advice might cause unnecessary further spread or autoinoculation. In addition, unnecessary exclusion of children with MC from school or daycare can cause many problems for families. If appropriate transmission advice was provided to these children’s families and schools, the stresses of parents taking off work and losing income or finding alternative child care could be prevented. While the appropriate advice was chosen more often than inappropriate advice, the percent respondents was low for most of the survey choices, including those which CDC recommends for transmission precautions ().
Overall, survey respondents were able to choose appropriate treatments and advice for MC patients. The survey revealed some potentially unnecessary or ineffective treatment choices for MC patients. MC, in a normal host, is benign and treatment is often unnecessary and can cause unwanted side effects. However the persistence of lesions may influence practitioners’ treatment plans. Respondents were generally able to provide appropriate hygiene advice to MC patients. Increased educational materials would be helpful to reinforce the recommendations to prevent spread to others and prevent autoinoculation. A better understanding of why non-standard advice is given will help to focus educational materials. Prevention of MC spread and autoinoculation can decrease anxiety and relieve burden of patients and physicians. Uniformity of recommendations and emphasis on low-cost, low-risk therapies and interventions would be beneficial as well. This survey has demonstrated that MC is a common skin infection seen by many types of health care providers and therefore guidance on treatment considerations and infection control is valuable.