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By Andrew J. Carlson, MD
January 26, 2013
Category: Diseases
Tags: Molluscum   Skin lesions   Skin bumps  


What is Molluscum Contagiosum?

Molluscum contagiosum is a common skin infection in children, with an increasing incidence.  It causes bumps that are flesh colored with a dimple or white “plug” on the top.  The bumps are small, about 2-5 millimeters in diameter (occasionally larger).  They can become red and inflamed, especially as the body begins to fight off the virus or if it becomes secondarily infected with bacteria.  The rash usually does not itch, hurt, or cause other symptoms.



What Causes Molluscum Contagiosum?

Molluscum is caused by the molluscum contagiosum virus, from the poxvirus family.  It is spread through direct skin to skin contact and contact with contaminated objects.  The incubation period is 2-6 weeks.  It can spread from person to person and from one part of a person to another part on the same body by direct contact or rubbing.  It can infect any skin and sometimes mucus membranes (lips, eyelid).  If on the eyelid, an ophthalmologist needs to be involved in treatment.

How to help prevent the spread of the virus?

  • Avoid touching, rubbing or scratching the bumps.
  • Don't share your clothing, towels, hairbrushes, razors or other personal items.

What is the Treatment?

Treatment for molluscum is not mandatory, but helps to control the spread to others.  Molluscum contagiosum is self resolving, if given time (6 months to 3 years).  There are also many treatment options with some benefit. 

The most common treatments involve either physically destroying the lesions or by boosting the body's immune response against the virus.

  • "Popping” the lesions to remove the central core. It can lead to spread of the virus, so must be done cautiously. It may lead to scarring.
  • Covering the lesions with duct tape overnight and removing in the morning for several weeks is a well-tolerated treatment by many children. This irritates the wart virus and helps remove the plug without spreading the virus as easily as popping might.
  • Freezing with liquid nitrogen, but this is often not well tolerated due to pain.  This might also induce scarring. 
  • Cantharidin (aka beetle juice) can be applied to each wart, up to 30 at a time. This causes a blister to form, destroying the wart. It can cause pain when the blister forms but is generally more tolerated than freezing. It cannot be done on the face, genitals, or between the buttocks.
  • Prescription creams that stimulate the immune response work for many of these warts, can be used on the face or genitalia/buttocks, and are generally well tolerated by children. The downside is high cost for most prescription plans. 
  • Imiquimod cream (Aldara) is approved for use in children over 12 years of age. It is applied at bedtime a few nights per week for 2-3 months. It is not FDA approved for molluscum, so its use is "off label". 
  • Tretinoin is an acne medicine that is sometimes used to treat molluscum, but does not have an official indication for this use, again "off label". It is applied several nights per week for a few months. 
  • Benzoyl peroxide (sold as acne treatments) can be applied and covered as an over the counter alternative, but it is another "off label" medicine.  It is also applied to the areas several nights per week for several months. Remember that Benzoyl peroxide can bleach the clothes, so wear overnight with a white shirt and wash off in the morning!
  • The oral medicine cimetidine has been used for treatment of molluscum in small children.  This medicine is available in liquid form only by prescription but is over the counter for those who swallow pills.  As with all medications, cimetidine may cause unwanted side effects, but is generally well tolerated and is taken twice daily for 2 months.

Although molluscum contagiosum is annoying, easily spread, and sometimes uncomfortable, it does not cause serious disease in most children. No treatment is 100% effective, and many children simply prefer to have the rash rather than the treatments. It is okay to leave these untreated and they will go away over time- 6 months to 3 years.



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