Berdazimer (Zelsuvmi) for the Treatment of Molluscum Contagiosum

Berdazimer (Zelsuvmi) is a topical, nitric oxide–releasing agent that is theorized to treat molluscum contagiosum through antiviral and immunomodulatory properties.¹ It is labeled for use in adults and children older than 1 year.² Berdazimer consists of two components: the active ingredient, berdazimer sodium, binds nitric oxide, and a hydrogel acts as a proton donor. Combining these two components before application forms the therapeutic agent that releases nitric oxide from the berdazimer sodium polymer in a controlled, localized, topical application.¹

Berdazimer is a generally safe medication, although allergic contact dermatitis may occur. There have been no other major adverse effects reported in adults or children older than 1 year. No data are available to support its safe use in pregnant or breastfeeding patients; however, it is considered safe to use during breastfeeding as long as infant contact with treated skin is avoided, and it is not applied to the nipple area.^3,4

The most common adverse effect is application site reaction. Pain, erythema, and pruritus are the most prevalent symptoms when these reactions occur. Adverse effects are typically mild or moderate and rarely severe.³ Discontinuation rates with normal use are less than 3% in studied populations, which are similar to placebo.¹

Berdazimer reduces the number of molluscum contagiosum lesions and can lead to complete clearance in some patients. In a phase 3 randomized controlled trial of 891 adults and children that compared berdazimer treatment with the hydrogel vehicle, 32.7% of patients taking berdazimer had complete clearance at 12 weeks (12.7% absolute risk increase; adjusted odds ratio = 2.0; 95% CI, 1.5–2.8; number needed to treat [NNT] = 8).⁵ A meta-analysis including this trial and two other studies found significantly higher rates of complete clearance in the berdazimer group at 8 and 12 weeks, with risk ratios of 1.73 and 1.54, respectively.⁶ The estimated absolute risk increase in the rate of complete clearance with berdazimer at 12 weeks in the meta-analysis was 10.8% (NNT = 9). Berdazimer has not been compared with cryotherapy, curettage, cantharidin (Ycanth), and imiquimod regarding effectiveness or patient satisfaction.

Berdazimer costs approximately $700 for one carton, which includes one tube of berdazimer gel and one tube of hydrogel.

Berdazimer may be difficult for patients to prepare and apply. The two components must be mixed using the provided dosing card and then applied to each lesion. Berdazimer must be applied immediately after preparation, which requires patients to prepare berdazimer daily before each application for up to 12 weeks. The treatment must dry for 10 minutes after application, and patients should avoid getting the area wet (eg, bathing, washing, swimming) for 1 hour.³