A Ped’s Perspective: Molluscum Contagiosum
Let’s continue our discussion that “kids are just rashy” with another common pediatric diagnosis: Molluscum Contagiosum.
This sounds like a concerning diagnosis, but it is generally a benign, mild skin eruption. Molluscum is a virus that is spread from direct skin to skin contact. Common places for transmission include swimming pools, baths, shared bath towels/washcloths which is why there seems to be increased occurrence in the summer months.
What does it look like?
Molluscum typically appear suddenly as round, raised, firm, dome shaped lesions with a central umbilicus (an indent that looks like a belly button in the center of the lesion). Lesions may be skin colored, pink, or red in color.
Symptoms:
Lesions are typically asymptomatic. They are most often found on the trunk and/or extremities, but can include the face or occasionally groin area. Lesions are often clustered, and tend to occur in skin folds or flexural areas like the armpits, upper thighs, or elbow/knee creases. Lesions do not tend to be bothersome or itchy, but I have seen lesions become red and itchy prior to spontaneous resolution.
Molluscum seems to be more common in areas with compromised or eczema prone skin. Unfortunately, lesions tend to spread with itching so I would try to manage any underlying eczema patches with very frequent moisturization and/or use of topical steroid creams if recommended by your child’s medical provider to avoid itching.
Treatment:
Typically no treatment is necessary for Molluscum lesions, and they resolve spontaneously on their own. However, Molluscum is not generally short lived, it can take 6 months- 2 years to spontaneously resolve. If lesions are left alone, they typically do not result in any scarring. If you notice your child picking or scratching at the lesions, distract and redirect the behavior, and treat the itching as needed with moisturizer or a small amount of Hydrocortisone 1% or Benadryl cream. I would recommend seeking medical evaluation if you notice any yellow or honey colored crusting over the lesions, new onset surrounding redness, or if your child is suddenly complaining that they are painful as this may be a sign of a secondary skin infection.
There are some treatment options, typically done by dermatologists, but they are often painful for kiddos and can increase the likelihood of scarring so I often do not recommend them. However, there are some considerations that warrant evaluation for possible treatment like location of the lesions (especially in the groin/private area), overall health/past medical history, number, and appearance of lesions. Molluscum is not caused by the same virus that causes warts, but it is in a similar family. The most common treatment option that I have seen is Cantharidin which is made from blister beetles, and has been used to treat warts and molluscum for many years. Another common practice is to freeze the lesions, but it is more painful so it is often not recommended for young kids. It is thought that the reason it takes so long for Molluscum lesions to resolve is because it is so benign that the body/immune system does not even see it as a threat, and some suspect that treatments simply trigger the body’s immune response to attack the virus more quickly.
So in general, I recommend treating any underlying eczema as outlined here, but otherwise leaving the lesions alone to resolve on their own in time.
