One of the most typical viral illnesses in children is molluscum contagiosum (MC). Even though it is typically benign and self-limiting, the danger of transmission and aesthetic problems necessitate treatment. There are numerous treatments available, including less effective topical medications and harsh invasive procedures (cryo, curettage). However, the majority of them are connected to discomfort, irritability, and scarring, which youngsters cannot endure well. Studies have shown that giving oral ranitidine to kids with MC is effective. For children with immunocompetent MC that is widespread or recurrent, oral ranitidine is regarded as a straightforward, efficient, and safe alternative treatment.
The most common cutaneous viral infection seen in children is called molluscum contagiosum (MC). The MC virus, a member of the Poxviridae family, is the culprit. The infection typically manifests as a single or few tiny, skin-colored or whitish papules with a recognisable central umbilication. Even though the infection is benign and self-limiting, people frequently seek treatment due mostly to concerns about appearance and contact transmission [1].
Treatment is frequently sought for cosmetic reasons, even though the condition is benign and self-limiting. A thorough Cochrane review conducted in 2009 found inadequate evidence to support the use of any one treatment as being unquestionably successful despite the fact that many different treatment modalities have been tried [1,2].
Treatment options range from unpleasant and damaging procedures like curettage, electrocauterization, cryotherapy, chemical cauterization using trichloroacetic acid, salicylic acid, or potassium hydroxide, and topical retinoids to immunomodulators such oral cimetidine and topical imiquimod. Destructive techniques may result in discomfort, irritability, scarring, pigmentation, and occasionally recurrence. According to a poll of parents of children with MC, scarring and discomfort were their top concerns. Therefore, a safe and efficient oral immunomodulator is urgently needed to treat a child's many molluscums [1,2].
Since T-cell-mediated immunity is primarily efficient against viral infections, immunomodulatory medicines appear to be a viable therapeutic alternative [2].
Ranitidine, a histamine receptor antagonist, is typically given to patients with peptic ulcer disease to reduce gastric acid output. Through the induction of delayed-type hypersensitivity, it has been discovered to have immunomodulatory effects [1].
Ranitidine functions as an H2 receptor antagonist and has a molecular structure that is different from both histamine and cimetidine. It has the advantage of not having any of cimetidine's antiandrogenic and hepatic enzyme-inhibiting properties, making it a more potent inhibitor than cimetidine. Its safety profile is better for infants, women who are pregnant or nursing, and the elderly. The medication is very well tolerated and has not been associated with any severe side events or clinically significant drug interactions [1,2].
Mechanism of action
It's unclear what the specific mechanism is. Cimetidine has previously been demonstrated to have positive immunomodulatory effects (enhancement of T cell immunity by inhibition of suppressor lymphocyte function). Ranitidine has been used to treat molluscum contagiosum, and this has been extrapolated to the molecule. By boosting the cluster of differentiation 4 (CD4) lymphocytes and lowering the cluster of differentiation 8 lymphocytes, ranitidine has an immunostimulatory effect. Additionally, it is predicted to boost the activity of natural killer, lymphokine- and interferon-activated killer cells. These cells' increased activity may be how ranitidine works to combat viruses. But, we must remember that cluster of differentiation 8 lymphocytes have an important role to play, in contributing towards antiviral immunity. Since the evidence of the role of ranitidine in molluscum contagiosum remains sketchy, studies with a larger sample size must be done, to have a clear idea regarding the utility of this molecule [3].
In this regards, In the multicentre longitudinal study done by Pooja Agarwal et al. [1] to assess the efficacy of oral ranitidine in treatment of molluscum contagiosum in immunocompetent children., 15 out of 19 patients who completed the treatment had improvement in the lesions at the end of 8 weeks while 4 patients did not show any improvement. Complete clearance was seen in 14 patients(73.6%) and 1 patient had decrease in size of the lesions without change in the number. Mean duration of complete clearance of lesion was 6.5 weeks.
Similarly, Chitalia AJ et al. [2] extrapolated the immunomodulatory effect of ranitidine and treated a child with recurrent multiple facial molluscums with oral ranitidine (5mg/kg/day in two divided doses) for 8weeks, who showed complete clearance in 6weeks with no recurrence even after 2 months of stopping therapy.
For immunocompetent children, Molluscum Contagiosum (MC) that is widespread or recurrent, oral ranitidine should be considered as a straightforward, efficient, and safe alternative treatment. Young children who cannot withstand unpleasant procedures like cryotherapy, curettage, or frequent visits for chemical application may find it to be especially helpful. According to theory, the medication boosts CD4+ lymphocytes while lowering CD8+ lymphocytes, which has an immunostimulatory effect. In children who are immunocompetent, ranitidine at a dose of 5 mg/kg/day in two divided doses is a useful alternative.
Agarwal, P. et al. "Oral ranitidine: A promising novel therapeutic option in molluscum contagiosum in children." Indian Journal of Drugs in Dermatology, vol. 5, 2019, pp. 26–29.
Chitalia, A.J. et al. "Oral ranitidine in molluscum contagiosum: A novel common treatment modality for a common disease." Clinical Dermatology Journal, vol. 3, no. 3, 2018, p. 166.
Das, A. et al. "What is new in dermatotherapy?" Indian Journal of Dermatology, Venereology and Leprology, vol. 87, 2021, pp. 135–143.