After the molluscum bumps have resolved, persistent skin discoloration called hyperpigmentation may be left alone and allowed to resolve over time. Alternatively, residual hyperpigmentation may be treated with prescription fading creams like hydroquinone 4%, kojic acid, or azelaic acid 15-20%. Over the counter fading creams with 2% hydroquinone may be available like Porcelana. Specially designed prescription creams for particularly resistant skin discoloration using higher concentrations of hydroquinone 6%, 8%, or 10% with a retinoid and a topical steroid may also be formulated by compounding pharmacists. Mild chemical peels and microdemabrasion may also help improve discoloration.
Guidance on prescribing topical steroids reminds practitioners to prescribe the least strong steroid which is effective for the least possible length of time. A balance must be struck between efficacy and reducing adverse effects. Education is crucial to maximise efficacy and reduce adverse effects. Use of printed information may be helpful (including detail of how to use emollients and topical steroids) and education involving practice nurses to help improve efficacy of treatments and information for patients. Examples can be obtained from the British Association of Dermatologists and the National Eczema Society.
All topical corticosteroids are classified category C by the US Food and Drug Administration, but some are classified category A by the Therapeutic Goods Administration ( /hp/medicines- ). Studies in animals have shown that topical steroids are systemically absorbed and may cause fetal abnormalities. Limited and inconclusive data are available for humans, however there seems to be an association between very potent topical corticosteroids and fetal growth restriction. 8 , 9 Caution is needed, but topical corticosteroids have been frequently used in pregnancy.