“I’m Only Human” #001: Molluscum Contagiosum
Molluscum Contagiosum in a child.
Classic appearance of molluscum contagiosum, a common viral infection spread by touch.
#001. Molluscum Contagiosum
Welcome to Little Spuds Pediatrics' new series, "I’m Only Human." Here, we talk about common health issues to make them feel normal. We don’t judge any symptoms; our goal is to help. This series is designed to educate parents about common childhood conditions, not to provide medical advice for your child's specific case. Now, let’s begin. First up: molluscum contagiosum.
Fast facts about Molluscum
Common, painless skin rash in children caused by a pox virus.
Appearance: fleshy/pearly bumps ~2-5mm in diameter, umbilicated center, has cheesy/white discharge if squeezed (do not recommend squeezing as this can cause rash to spread).
Occurs mostly on face, trunk, limbs, armpits or back of knees. Spares palms & soles. Starts as small pinhead sized bumps and continues to increase in size and number, may crop up in clusters.
In immunocompromised children, the molluscum can spread extensively and be larger in size.
Spreads easily by contact: person to person with direct contact activities like sports OR when a person touches an item the pox virus exists on: towels, surfaces, toys, razors, bedding, sports equipment, & more.
Molluscum is also spread easily during sex. Sexually transmitted molluscum is typically located in the anogenital area, abdomen and inner thighs. Lesions in these areas in young children are often due to self inoculation (scratching lesions and touching these areas).
Typically enters through small scratch/break in the skin, rash typically develops 2 - 6 weeks after exposure, though has been reported to develop up to 4-6 months after exposure.
Rash typically goes away on own without treatment in about 6-12 months, though can take longer, even up to several years.
Scratching and/or picking the bumps can make the rash can spread across the body and cause a secondary bacterial skin infection and/or prolong the infection.
Ok to continue participation in sports and attend school as long as the bumps can be kept covered during participation with a bandage or clothes. Advise discussing what is best with a pediatric provider.
Prevention
Prevention is through good handwashing; keeping wounds covered when in public parks/locations; not sharing items with infected individuals where the virus can exist, like towels, razors, bedding, sports equipment, & more.
Sexually transmitted molluscum can be prevented by not having sex with someone who has an active infection and using safe sex practices like using condoms.
Despite our best prevention efforts, kids can still get molluscum.
To Treat or Not to Treat, That is the Question…
A provider may recommend treatment other than time if:
Molluscum occurs in a child with an underlying condition like eczema.
Molluscum occurs in a child with a weakened immune system.
Molluscum is extremely bothersome or extensive.
Molluscum is in the genital area.
Treatments
Time
Giving molluscum time to resolve on it’s own is the most common practice. One study of 170 children found at 12 months time 50% of children had complete clearance of molluscum without any treatment and at 18 months, 70% had clearance without treatment. Note: sexually transmitted molluscum is generally treated by a trained provider.
Avoid picking/squeezing/scratching the bumps to prevent spread across the skin.
Follow best practices to prevent spread to household contacts or others in the community: frequent handwashing; keep wounds covered when in public parks/locations; avoid sharing towels, tubs, sports equipment, razors and other items where the virus may exist.
Removal
Physical removal: this includes cryotherapy, cantharidin, curretage, and laser therapy. Requires a trained provider and often multiple treatments are necessary without guaranteed resolution. Common side effects for many of these procedures may include pain, itching, swelling, redness, and scarring.
Cryotherapy: a trained provider applies liquid nitrogen to each lesion. One study of 54 patients found this treatment to have a 94% clearance rate, though may require more than 1 treatment to clear. This is not a preferred treatment in pediatrics due to pain and scarring.
Cantharidin (Ycanth): for children >2 yrs of age: a trained provider applies the treatment in office every 3 weeks up to 12 weeks (up to 4 treatments). Two double-blind randomized placebo-controlled studies found after 4 treatments, Ycanth cleared 54% of the participants’ molluscum. Common adverse effects reported in studies include blistering, pain, redness, swelling, itching and scarring.
Curretage: a trained provider numbs the skin and uses an instrument to scoop out the bumps. Typically requires 1-2 in-office treatments. A retrospective study found a 70% cure rate from this treatment after one session, but it is not typically done in children and requires a knowledgeable provider to perform. Adverse effects include pain & scarring.
Pulse Laser Therapy: A trained provider uses a pulsed laser to remove lesions. One study showed 42 of 43 patients cleared with one treatment, indicating high effectiveness. Disadvantages include being non-first-line, limited availability, lack of insurance coverage, and higher cost compared to other methods.
Medication
Cimetidine - Typically taken once a day by mouth for 2 months. Not a first-line treatment for pediatrics, but often considered safe. Evidence indicates it may not clear facial molluscum and can have side effects. Advantages include being painless and easy to administer. Disadvantages are the need for daily medication for 2 months and possible side effects like nausea, diarrhea, rash, and dizziness. Therapy initiation requires discussion with a healthcare provider.
Topical therapies: Evidence is available these treatments may be beneficial, but not all are recommended for use in children. May include:
salicylic acid
tretinoin
benzoyl peroxide
potassium hydroxide
The mechanism of action is thought to stimulate irritation, prompting the immune system to eliminate lesions. Advantages include at-home application by parents. Disadvantages may involve burning, pain, and risk of secondary skin infections. Discuss options with a knowledgeable healthcare provider before starting.
Summary
Molluscum is a very contagious, painless, viral skin rash occurring during childhood that generally resolves on its own with a little tincture of time. While there are several treatment options available, none are guaranteed to clear molluscum for all children. Treatment should be considered for sexually transmitted infections, people with weakened immune systems, those with severe infections, and individuals with conditions like eczema. Treatment can be painful and anxiety-inducing for some children but not for others, this should be considered when deciding to proceed. Initiation any of these therapies for a child should be discussed with a knowledgeable healthcare provider first. Early treatment with fewer bumps may lead to better outcomes. If your child has a molluscum rash and you want to discuss any of the above treatment options, please request a visit here.
References
Badri T, Gandhi GR. Molluscum Contagiosum. (2023, Mar 27). In StatPearls. Treasure Island (FL): StatPearls Publishing. Retrieved Dec 17, 2024 from https://www.ncbi.nlm.nih.gov/books/NBK441898/
Basdag, H., Rainer, B. M., & Cohen, B. A. (2015). Molluscum contagiosum: to treat or not to treat? Experience with 170 children in an outpatient clinic setting in the northeastern United States. Pediatric dermatology, 32(3), 353–357. https://doi.org/10.1111/pde.12504
Chapa, P. J., Mavura, D. R., Philemon, R., Kini, L., & Masenga, E. J. (2021). Contributing Factors and Outcome after Cryotherapy of Molluscum Contagiosum among Patients Attending Tertiary Hospital, Northern Tanzania: A Descriptive Prospective Cohort Study. Dermatology research and practice, 2021, 9653651. https://doi.org/10.1155/2021/9653651
Eichenfield, L. F., Kwong, P., Gonzalez, M. E., Yan, A., D'Arnaud, P., Burnett, P., & Olivadoti, M. (2021). Safety and Efficacy of VP-102 (Cantharidin, 0.7% w/v) in Molluscum Contagiosum by Body Region: Post hoc Pooled Analyses from Two Phase III Randomized Trials. The Journal of clinical and aesthetic dermatology, 14(10), 42–47. https://pubmed.ncbi.nlm.nih.gov/34976290/
Harel, A., Kutz, A. M., Hadj-Rabia, S., & Mashiah, J. (2016). To Treat Molluscum Contagiosum or Not-Curettage: An Effective, Well-Accepted Treatment Modality. Pediatric dermatology, 33(6), 640–645. https://doi.org/10.1111/pde.12968
Luddman, P. (2023, Nov 6). Molluscum Contagiosum: Diagnosis and Treatment. American Academy of Dermatology Association. https://www.aad.org/public/diseases/a-z/molluscum-contagiosum-treatment#:~:text=Pulsed%20dye%20laser%20(PDL):,to%20another%20dermatologist%20for%20treatment.
Meza-Romero, R., Navarrete-Dechent, C., & Downey, C. (2019). Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clinical, cosmetic and investigational dermatology, 12, 373–381. https://doi.org/10.2147/CCID.S187224
**Information in this article not intended to be direct medical advice, for general educational purposes only.**