Acute ulceronecrotic adverse reaction to potassium hydroxide 5% solution in the treatment of molluscum contagiosum

Abstract

Molluscum contagiosum is a common childhood condition, and although it is self-limited, treatments are often prescribed.Several medications are available, but there is no consensus regarding the optimal choice in the pediatric population. We report a child who underwent potassium hydroxide 5% treatment resulting in superficial diffuse erosions caused by the inappropriate application. This underlines the importance of parent education before use of this medication with well-known caustic properties. | 225Pediatric Dermatology BRIEF REPORT in domestic accidents. It is capable of deep penetration, and tissue destruction can continue long after the initial contact with the chemical. 5Among topical preparations used to treat MC, keratolytic KOH solutions at different concentrations (5%, 10%, and 15%) are the least expensive and are frequently used in the pediatric population. 6,7 Several studies have reported them to be safe, effective, and well-tolerated in children 2,8,9 Adverse effects include mild-to-moderate stinging and pigmentary changes; rarely, KOH may cause small erosions and scarring. The lower the concentration, the safer the application. 7-9 In our patient, despite the 5% concentration, misuse of the preparation caused a significant irritant and erosive response.Choosing the most appropriate therapy for molluscum contagiosum requires the consideration of physician experience; the number, severity, and anatomic location of the lesions; and the patient's age, skin phototype, and sociocultural background, as well as any parental language barrier or other barriers to comprehension. Specific instructions need to be given and proper parental comprehension of the method and timing of application should be confirmed. Despite its apparent ease in handling, KOH solution must be prescribed cautiously to prevent misuse and adverse reactions.