In this month’s blog post, our nurse practitioner, Rebecca Bartlett, MSN, APRN, FNP-C, shares her own daughters’ struggles with the ubiquitous bane of preschooler parents: the Molluscum Contagiosum Virus.
It’s that time of year again for teachers and parents. It’s molluscum outbreak time!!! Errrr….I mean back to school!!! As most parents can attest, sometimes back to school means back to the pediatrician’s office. Children sharing germs seems to be part and parcel of children spending time together in shared places. While there are seemingly countless germs for the preschool and early elementary set to share, one of the most common ones in skin is “molluscum contagiosum”. As the name implies, it is highly contagious. Thanks to their friends, peers, or cousins, my own children have spent the greater part of a year battling their own molluscum outbreak.
What Is Molluscum Contagiosum?
Molluscum contagiosum is a common, self-limited viral infection of the skin. It is caused by a pox virus conveniently name “Molluscum Contagiosum Virus” or MCV. They appear as tiny, painless pink-white “bumps” with a delled (doughnut) shape on the skin. Molluscum usually starts as a solitary lesion, but can rapidly spread to clusters of pink bumps appearing anywhere on the skin, including the face, diaper area, arms, legs, and trunk. Children with atopic dermatitis (or eczema) are more likely to suffer widespread infection. Molluscum is spread through direct contact with infected skin or through toys, towels, or sports equipment. Additionally, warm, moist environments increase the transmission of the virus – yet another charm of living in Central Louisiana!
Although molluscum is generally harmless, it can continue to spread and become a nuisance. Sometimes it may become secondarily infected with skin bacteria (= a “Staph infection”). Molluscum generally resolves on its own, but it may take years to do so and it may (rarely) leave scars in its wake. To expedite the resolution of molluscum, there are various treatment options available.
Common Treatment Options for Molluscum
In truth, molluscum does not require treatment at all (=benign neglect). This “wait it out” approach may be a legitimate option for some, but bear in mind these lesions can take up to FOUR years to resolve on their own. So, if molluscum is widespread or spreading, treatment of the lesions is indicated. Sadly, as molluscum is caused by a virus, it is more difficult to treat than bacterial skin infections. There is no “quick fix” prescription: the child’s own immune response must attack the virus causing the molluscum or you must physically remove each individual growth (ouch!). Alas, consider molluscum yet another “growing pain”. Treatments can be divided into two categories: at home (likely less painful) versus in-office treatments (bribery may be required). Sometimes more than one modality is necessary,
In my household, we chose topical therapy with a prescription retinoid cream. Topical retinoids are FDA-approved to treat acne (and wrinkles ), but have an annoying side effect of skin irritation. It is this mild irritation that disrupts the viral particles and creates a cytokine response in which the body’s immune system directly fights the molluscum virus. Despite careful application, it is normal for the skin surrounding the molluscum to become red, dry, and flaky. This signals skin irritation, which is good! If, however, the skin around the molluscum becomes very red, tender, swollen, or hot, there is likely a secondary bacteria (“Staph”) infection. This requires the addition of a topical antibiotic ointment. Using topical retinoids to treat molluscum is a relatively safe and gentle method; however, it may take a little longer to treat the MC using this option and it involves work on the parent’s part to apply the cream daily.
PROS: Low to no tears, ability to treat new lesions as they arise
CONS: Another nightly chore for parents, may sting as dermatitis sets in, may take weeks to work on each spot
For spots that have failed topical at home treatments, consider in office destructive treatments. These include cryotherapy (“freezing” the MC) or the use of a topical skin blistering agent called cantharadin (or “beetle juice” as this agent is derived from a beetle) or curettage (“scraping” each individual lesion). As each option, may involve some degree of discomfort or may result in scarring or discoloration, they are generally reserved for more severe or recalcitrant cases of molluscum.
PROS: Ideally “faster” results than at home treatments
CONS: Pain/discomfort within the office or hours later at home, likely higher cost depending upon your health insurance, additional treatments may be required (and your child will remember the waiting room and may get upset pre-treatment)
How WE Approach Molluscum at RRD
We base our treatment plans on the following:
- How extensive is the molluscum?
- How visible are the lesions?
- Are the lesions itchy?
- Does the child have eczema or atopic dermatitis?
- How old is the child?
- Can the child tolerate a potentially painful procedure well?
- Is the child or parent bothered by them?
- Are there other children in the house?
- Does the child or any household member have a history of staph infections?
We breakdown treatment options as below:
- Decrease the spread of Molluscum
- Minimize itch and eczema with topical steroids, barrier repair or anti-itch creams
- Consider dedicated towels in the household
- Avoid baths with siblings
- Keep affected skin covered with clothing or watertight bandages
- Do not pick or scratch at lesions
- Create an immune response to the Molluscum
- Consider oral cimetidine/ranitidine for extensive lesions
- Irritate existing lesions as tolerated with topical retinoids, KOH (potassium hydroxide) salicylic acid, betadine or other topicals applied at home
- Consider in-office destructive therapies as tolerated:
- Light cryotherapy with liquid nitrogen
- Curettage (or scraping) of each lesion
- Treat any concurrent “Staph” infections:
- Bleach baths
- Topical antibiotics as needed
How to Prevent the Spread of Infection?
- Proper hand washing
- Avoid sharing fomites like towels, toys or sport equipment
- Wear watertight bandages to cover molluscum lesions when clothing cannot cover
- Do not pick or scratch at lesions
As the MC virus is everywhere (=ubiquitous), it is hard to prevent this virus from entering your home during the early parenthood years. While the best defense is the good offense (hand washing plus Clorox wipes for the fomites), it is not foolproof especially for the wee ones in our lives. So, if that back to school bell brings with it some new friendly molluscum “bumps” please know that you are not alone 😉, you are not a parent failure, and that we are here to help you create a treatment plan that works for you and your family.
For more information:
If molluscum has invaded your space, contact us at Red River Dermatology for an appointment to determine your (or your child’s) best treatment options.