Molluscum Contagiosum

We have discussed before how I am not a huge fan of rashes… but I am comfortable with being able to look for the characteristics of the more concerning ones (ex, petechiae, purpura, vesicles, bullae, target lesions, desquamation).  With that being stated, there are some useful, common childhood rashes to know, like pityriasis rosea; however, if I call pitryiasis a nonspecific “dermatitis” I don’t feel terrible.  Yet, in the quest to continue to improve our knowledge base, let’s look at Molluscum Contangiosum.
a)    Molluscum Contangiosum…
o    Is a common skin condition caused by a poxvirus.
o    Is similar to warts in that it is benign and contained to the skin.
o    Is due to the virus entering the skin, via breaks in the skin, and producing papular growths, which can occur anywhere.
o    Papules are often dome-shaped and are flesh-colored or pink. They can become red when irritated (particularly after the kid has been scratching at them).

b)    As it’s name would imply, the rash is contagious.
o    Spread by skin-to-skin contact.
o    Often increased in number in areas with skin folds.
o    Can be seen in clusters or in rows.
o    Can spread person to person as well.
o    Possible to spread via fomites.
♣    Towels, toys, clothing, and gym mats.
♣    Also reportedly from swimming pools.

c)    Virus likes warm climates… so tropical areas have increased risk.
d)    Immuno-compromised patients can have large and cosmetically concerning outbreaks.
e)    Treatment:
o    Traditionally it is taught that there is no therapy. Molluscum will heal without therapy without scarring.
o    Dermatology literature discusses liquid nitrogen, blistering solutions (Cantharidin – AKA “BettleJuice” – derived from beetles), electrocautery, laser therapy or excision as means to remove the papules.
o    Cochrane Library notes: “there is not enough evidence to show that any partular treatment is effective for treating molluscum infection.”
o    Newer literature does note improvements with salicylic and lactic acid, but the study is of a small population.
o    Additionally, in male patients, Podophyllotoxin Cream (0.5%) or Imiquimod 5% cream can be applied.
o    In the end, there are some options to help resolve a spontaneously resolving condition a little sooner and perhaps reduce its spread.
o    Consider Dermatology referral in cases where the papules are in cosmetically sensitive areas or in patients with reduced immune systems.

Sean M. Fox
Sean M. Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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