Overview
Molluscum contagiosum is primarily found on children under the age of 10 years. These 2 to 5 mm discrete dome-shaped papules indicate a very common viral infection caused by the poxvirus. They present most frequently in grouped clusters, white, pink, or brown in color with a waxy appearance. They are umbilicated with a central pit that contains a white cheesy material when expressed. A child can have a solitary papule or hundreds over several areas of the body. They are most commonly found on the face, trunk, axillae, extremities. They do not occur on palms or soles.
Lesions can become inflammatory and/or pruritic. They can be complicated by secondary bacterial infections. It is important to note, they are infections and can spread via autoinoculation, scratching, or touching a lesion and fomites. Others can become infected by direct skin-to-skin contact or indirect contact via shared towels or other items.
Management
The treatment for molluscum is highly individualized for each patient. There is currently no agent to kill the virus and no perfect treatment exists for molluscum contagiosum. Due to the likelihood of self-resolution within months, a major consideration in treatment is preventing treatment induced scarring. The most commonly used and effective treatments include cryotherapy or cantharidin solution, a chemical extract from the blister beetle. Other lesser used treatments include physical removal with curettage or forceps, potassium Hydroxide 5%, Podophyllotoxin 0.5%, Hypoallergenic Surgical Adhesive Tape, Salicylic Acid, laser therapy, and natural remedies that have lower efficacy.
In immune competent hosts, molluscum contagiosum is relatively harmless, usually clearing in 12-24 months. Reinfection can occur. Infections can be very persistent in the presence of significant immune deficiency or in those with atopic dermatitis.
While molluscum contagiosum is infectious while active, it is recommended that children continue to attend daycare or school. Efforts should be made to reduce spreading the virus to others, such as, keeping hands clean, avoiding scratching lesions, covering all lesions with clothing or watertight bandages, proper disposal of used bandages, no sharing of towels, clothing, or other personal effects.
Written by Amanda Floyd, APRN