After decades without a single FDA-approved option, molluscum contagiosum finally has not one but two prescription treatments available in the United States. The first breakthrough came on July 21, 2023, when the FDA approved YCANTH (cantharidin 0.7% topical solution), developed by Verrica Pharmaceuticals, for use in patients two years of age and older. Then in January 2024, the FDA approved ZELSUVMI (berdazimer topical gel, 10.3%), the first at-home prescription treatment for the condition, now commercially available as of July 2025 through Pelthos Therapeutics.
For the millions of families and individuals dealing with these persistent, sometimes embarrassing skin bumps, this is a genuine turning point. Before these approvals, dermatologists relied entirely on off-label methods like cryotherapy, curettage, and compounded cantharidin solutions that were never standardized or formally studied for this particular virus. A parent bringing a child to the dermatologist for molluscum would often hear some version of “we can freeze them off or scrape them, but there’s nothing specifically approved for this.” That era is now over. This article covers how these two treatments differ, what the clinical trial data actually shows, the practical realities of cost and access, and what caregivers — particularly those managing skin health for older adults with cognitive decline — should know about these options.
Table of Contents
- What Does FDA Approval of a Molluscum Contagiosum Cream Actually Mean for Patients?
- How YCANTH Works and Where It Falls Short
- ZELSUVMI Brings Treatment Home for the First Time
- Comparing YCANTH and ZELSUVMI — Which Treatment Fits Which Patient?
- The Cost Problem No One Wants to Talk About
- Why Molluscum Contagiosum Matters in Dementia Care Settings
- What Comes Next for Molluscum Treatment
- Conclusion
- Frequently Asked Questions
What Does FDA Approval of a Molluscum Contagiosum Cream Actually Mean for Patients?
To be precise, the term “cream” in common parlance covers what are technically two different formulations. YCANTH is a topical solution delivered through a single-use applicator and must be administered in a healthcare provider’s office. ZELSUVMI is a topical gel that patients or caregivers can apply at home. Neither is a traditional cream in the pharmacy aisle sense, but both represent a sea change for a condition that the medical establishment had largely treated with improvised approaches. The practical difference matters enormously. YCANTH requires office visits — a trained professional applies the cantharidin solution directly to each molluscum bump.
In clinical trials, 54% of patients achieved complete clearance of all treated lesions by day 84, compared to just 13% with placebo. That is a meaningful result, but it means repeated trips to the dermatologist, which can be difficult for elderly patients with mobility issues or those living in memory care facilities. ZELSUVMI, by contrast, can be applied at home by a caregiver or the patient themselves, which opens up treatment access for populations who struggle with frequent medical appointments. For families managing dementia alongside other health concerns, the at-home option is particularly relevant. Skin conditions in older adults with cognitive impairment often go undertreated simply because getting to a specialist appointment is logistically overwhelming. Having a prescription gel that a home health aide or family caregiver can apply changes the calculus entirely.
How YCANTH Works and Where It Falls Short
YCANTH uses cantharidin, a blistering agent derived from blister beetles that has actually been used by dermatologists in compounded form for decades. What Verrica Pharmaceuticals did was create a standardized, FDA-regulated version — a 0.7% topical solution in a single-use applicator that ensures consistent dosing. The mechanism is straightforward: cantharidin causes a blister to form beneath the molluscum bump, which lifts it away from the skin as it heals. The limitation is the in-office requirement. Each treatment session means scheduling an appointment, getting to the clinic, and having a provider carefully apply the solution to individual lesions.
For a child with a handful of bumps on their arm, this is manageable. For an older adult in a care facility with dozens of lesions — molluscum can spread aggressively in immunocompromised individuals — the logistics become burdensome quickly. Additionally, because cantharidin causes blistering, there is a window of discomfort after treatment, and patients with cognitive impairment may not understand why their skin hurts or may pick at treated areas, complicating healing. However, if a patient has only a few isolated lesions and can tolerate office visits, YCANTH’s higher clearance rate (54% versus ZELSUVMI’s 32.4%) may make it the stronger clinical choice. The tradeoff between efficacy and convenience is real, and dermatologists will weigh this differently depending on the patient’s overall situation.
ZELSUVMI Brings Treatment Home for the First Time
ZELSUVMI received fda approval in January 2024, and Pelthos Therapeutics commercially launched the product on July 10, 2025 in the United States. It is available through retail pharmacies, ASPN pharmacy services, and mail-order pharmacies. The active ingredient, berdazimer, is a nitric oxide-releasing agent — it works by delivering nitric oxide to the skin, which has antiviral properties that help the body clear the poxvirus causing the bumps. The B-SIMPLE4 clinical trial enrolled 891 patients and found that 32.4% achieved complete lesion clearance at week 12, compared to 19.7% with a vehicle placebo.
Those numbers are more modest than YCANTH’s, but the context matters: this is a treatment patients apply themselves at home, which means far greater consistency of use and no missed appointments. For a caregiver applying gel to an elderly parent’s skin lesions three times a week in the comfort of their home, the convenience factor may ultimately produce better real-world outcomes than a theoretically more effective treatment that requires clinic visits the patient keeps missing. Common side effects include burning at the application site, redness, and itching. These are generally mild but worth noting for dementia patients who may not be able to articulate discomfort. A caregiver should monitor the treated skin closely, especially in the first few applications, to gauge tolerance before continuing with the prescribed regimen.
Comparing YCANTH and ZELSUVMI — Which Treatment Fits Which Patient?
The choice between these two treatments is not simply about which one “works better” on paper. YCANTH’s 54% complete clearance rate at day 84 is clearly superior to ZELSUVMI’s 32.4% at week 12 in controlled trials. But clinical trials measure efficacy under ideal conditions, and ideal conditions rarely describe the life of a dementia caregiver managing a loved one’s skin infection alongside medication schedules, behavioral symptoms, and their own exhaustion. YCANTH is the better fit for patients who can reliably attend dermatology appointments, have a limited number of lesions, and have a care team that can manage post-treatment blistering.
ZELSUVMI is the better fit for patients who are homebound, live in residential care, have widespread lesions that would require multiple office sessions, or whose caregivers need a treatment they can administer independently. ZELSUVMI is also approved down to age one, versus age two for YCANTH, though this is more relevant in pediatric contexts. One important caveat: neither treatment is a guaranteed cure on the first course. Molluscum contagiosum is caused by a poxvirus, and the bumps can recur, especially in immunocompromised individuals. Patients and caregivers should discuss with their dermatologist what a realistic treatment timeline looks like and whether repeat courses or combination approaches might be needed.
The Cost Problem No One Wants to Talk About
ZELSUVMI carries a retail price of approximately $2,338.83 for 31 grams, with discount programs like GoodRx bringing that down to roughly $1,910.54. For a condition that many people — and even some insurers — consider cosmetic or self-limiting, getting coverage can be a fight. Pelthos Therapeutics has signed a major pharmacy benefit manager agreement to expand patient access, but the reality on the ground is that many patients will face prior authorization hurdles or outright denials. This is especially concerning for older adults on fixed incomes or those whose care is managed through Medicare or Medicaid, where formulary coverage for newer dermatologic treatments is unpredictable.
A caregiver who secures a prescription for ZELSUVMI may arrive at the pharmacy to discover a copay that is simply unaffordable. It is worth asking the prescribing dermatologist about patient assistance programs, copay cards, or whether the older compounded cantharidin route — while not FDA-approved — remains a viable and cheaper alternative for their specific situation. The cost of YCANTH is folded into office visit charges in many cases, but repeated visits add up as well, particularly when factoring in transportation, time off work for caregivers, and the stress of getting a confused or resistant patient to yet another appointment. There is no cheap option here, and families should go in with realistic expectations about what their insurance will and will not cover.
Why Molluscum Contagiosum Matters in Dementia Care Settings
Molluscum contagiosum spreads through direct skin contact and shared surfaces — exactly the conditions found in assisted living facilities and memory care units. Residents with dementia may scratch or pick at bumps without understanding the consequences, spreading the virus to other parts of their body or to fellow residents and staff. Outbreaks in congregate care settings are not widely reported but they do happen, and until recently there was no standardized treatment protocol to point to.
Having FDA-approved options gives facility medical directors and consulting dermatologists a clear, evidence-based path forward. A facility can now establish a treatment protocol using ZELSUVMI for residents, administered by nursing staff as part of routine skin care, rather than trying to arrange specialist visits for every affected resident. This is a quiet but meaningful improvement in the standard of care for a vulnerable population.
What Comes Next for Molluscum Treatment
The approval of two distinct treatments within roughly six months of each other suggests growing pharmaceutical interest in a condition long considered too minor to invest in. With both YCANTH and ZELSUVMI now generating real-world data beyond their clinical trials, expect to see head-to-head comparisons, combination therapy studies, and further refinement of treatment guidelines over the next several years.
For caregivers and patients, the immediate future holds the more mundane but equally important work of expanding insurance coverage, driving down costs, and training primary care providers — not just dermatologists — to prescribe and manage these treatments confidently. The FDA approvals were the necessary first step. Making these treatments actually accessible to the people who need them is the harder, longer project that lies ahead.
Conclusion
After years of relying on off-label freezing, scraping, and unstandardized compounded solutions, molluscum contagiosum now has two FDA-approved treatments with real clinical data behind them. YCANTH offers higher clearance rates through in-office application, while ZELSUVMI provides the first at-home option that caregivers can administer independently. For families navigating dementia care, where every additional medical appointment is a logistical challenge, having a home-based treatment option is a practical advancement worth discussing with a dermatologist.
The next step for anyone dealing with molluscum — whether personally or as a caregiver — is a straightforward conversation with a healthcare provider about which treatment fits the patient’s living situation, insurance coverage, and tolerance for side effects. Neither option is perfect, and cost remains a real barrier. But for the first time, there are actual approved tools in the toolbox, and that alone represents genuine progress.
Frequently Asked Questions
Is molluscum contagiosum dangerous for elderly people with dementia?
Molluscum contagiosum is generally not dangerous, but in older adults — particularly those who are immunocompromised or living in group settings — it can spread extensively and become a persistent nuisance. The bigger risk in dementia patients is secondary infection from scratching or picking at the bumps.
Can a home caregiver apply ZELSUVMI, or does it require medical training?
ZELSUVMI is specifically designed for at-home use and does not require medical training to apply. A caregiver applies the gel directly to the bumps as directed by the prescribing physician. Monitoring for side effects like burning or redness at the application site is recommended.
Does insurance typically cover these new molluscum treatments?
Coverage varies widely. Some insurers classify molluscum treatment as medically necessary, while others consider it cosmetic. Pelthos Therapeutics has signed a pharmacy benefit manager agreement to improve ZELSUVMI access, but patients should expect the possibility of prior authorization requirements or coverage denials and ask about patient assistance programs.
How long does it take for these treatments to work?
In clinical trials, YCANTH achieved 54% complete clearance by day 84 (about 12 weeks). ZELSUVMI showed 32.4% complete clearance at week 12. Results vary by individual, and some patients may need additional treatment courses.
Are there any at-home remedies that work as well as these FDA-approved treatments?
No over-the-counter or home remedy has been shown in rigorous clinical trials to match the efficacy of YCANTH or ZELSUVMI. Some people try tea tree oil or apple cider vinegar, but these lack clinical evidence and can irritate the skin. The virus does resolve on its own over time — sometimes months, sometimes years — but approved treatments offer a faster, more reliable path to clearance.
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