What is it?
Molluscum is a wart like growth that can occur anywhere on your skin. They are 1-3mm (rarely as large as 15mm) round, raised, dome shaped, skin color to slightly pink, have a translucent to barely white core, and often have a dimple or belly button appearance on the top. They can occur on any skin surface from torso to eyelids, genitalia, ANYWHERE you have skin, ……. yes there too!
What causes it?
Molluscum is a viral infection cause by a virus in the Molluscipox family.
How do you catch it?
- The virus is usually spread by direct contact. You will see this on the child that has lesions on one area of skin that regularly touch another will result in new lesions where they touch.
- The virus might be spread by fomites. This is dried virus left on a surface that your child then touched and the virus then invaded the skin and caused the infection.
- The virus is also spread by a child scratching the lesions, getting the virus under the nail, and then scratching another skin surface imbedding the virus in that new surface.
- There are theories about warm water. There appear to be clusters of cases where children bathe in hot water or share warm pool or hot tub water. There have been a few epidemics reported from pool contact, but it is not known 100% that those children did not have direct contact to spread the virus. There is a general consensus that children with exposed Molluscum should not bathe to prevent spread on their own body, also wash the area with lesions last, so as to prevent spread after touching the lesions (wash clothes might abraid the lesions and spread it). Children with Molluscum should not bathe with other children in the same tub at the same time to prevent spread. Clean the tub with bleach after use. There is debate about whether children with Molluscum should avoid swimming pools to prevent spread to other children. Certainly a child with Molluscum should not use a hot tub to prevent spread on their body and to others. It is generally not known how long the virus will survive off a human, but it is uncommon for people to catch Molluscum from general use of a hot tub without an infected individual being in the hot tub at the time.
- CAUTION: The virus CAN be sexually transmitted in adults for obvious skin to skin contact reasons. It is not considered sexually transmitted in children unless there are significant other reasons to suspect this occurring. If there is absolutely no other reason to suspect abuse, then this is extremely unlikely to be a source. CAUTION! I have seen thousands of children with molluscum and have yet to feel that even one was sexually transmitted.
How common is it?
Most parents have never heard of it, but we see it quite regularly in the office. I have seen as many as 2-3 patients in a day with it. I don’t know of any studies giving exact numbers. Two of my children had it separated by 2 years, therefore obtained from different sources.
Will they go away?
Molluscum almost always resolves on its own , but this can be as short as a few weeks and as long as a few years.
What can happen if we don’t treat them?
- Usually nothing happens, they just go away.
- Because the virus invades and replaces the supporting structure of the skin, sometimes there is a acne-scar-like or chicken-pox-scar-like area left where the lesions were. This generally occurs with the larger lesions, when they become inflamed, and on thinner skin like the face.
- Usually the lesions just fall off, but occasionally they become festered. They become inflamed, develop a white head like an infected bug bite or large acne, the core comes out and they heal like any other wound would heal. This is not really an infection in sense you would think of an infected bug bite, its just the immune system expelling the virus.
- The lesions sometimes occur in areas where clothing or skin rubs and become quite irritating.
- Because children’s hands often wander on their own bodies, these lesions can and do occur in the genital area. This can be quite alarming to other relatives, daycare workers, etc.
How do we treat them?
- First remember that they usually go away on their own, but its unpredictable when.
- The first treatment I recommend is over the counter and cheap. www.molluscumrx.com is a web site that sells a homeopathic mixture called MolluscumRx. Parents report about 50% success within 3-4 weeks. The current known cost is $30. Some parents have report finding it at local pharmacies, but I am not sure which ones. FOLLOW DIRECTIONS and use for the time recommended. If it does not work in that time or after one bottle, it is most likely not going to work.
- Aldara is a moderately expensive prescription cream that up-regulates your immune system where it is applied and is about 85% effective. It was originally used for genital warts, so it’s safe to use pretty much everywhere. It’s applied with a toothpick 3 times a week directly on the lesions only. It can be used more often. It takes at least 4 weeks to see any change and can take up to 16 weeks or more to work. If no change is seen at 6-7weeks, it’s unlikely to work. Bad news is that kids with dry skin often get inflamed skin next to where the medicine is applied. If this happens, you must stop the medicine in that area.
- Curetting: If you have ever heard of a wart that goes away when you remove the core, then this is the type of wart they were talking about. This does not work for other warts. We apply a numbing cream (takes a hour to work and is not 100% effective) and use something like a melon baller and scrape the lesions off. This is immediately effective and works almost 100% of the time. But the lesions often bleed a bit, there is pain after the numbing wears off, and it is not a favored treatment by just about anybody.
- Cantharidin: This is a beetle toxin applied by a dermatologist.The chemical is almost 100% effective, but the chemical often causes significant blistering and pain and is also not a favored treatment by most.
- Liquid Nitrogen: Liquid nitrogen can be applied in our office. We apply 2 20-second applications of -192 degree C liquid nitrogen directly to each lesion. It feels like a stinging pinch. Most kids can tolerate 8-10 lesions being treated at one session, but for more lesions they often need sedation. The treatment is almost 100% effective. Essentially we give the lesions frostbite. Sometimes the lesions look like bee stings for a few hours after treatment, then either turn to a frostbite appearance or just fall off in 2-3 weeks. If all previous treatments don’t work, there are more than 10 and you still want them removed, then I can take the child to the operating room at Woman and Childrens Hospital and freeze all of them off. The anesthesia department administers the anesthesia and I freeze the lesions. I have treated as much as 190 on one child in this manner. We can discuss the details of this whenever you wish.
When should I call the doctor?
• If the above plan does not work
• If they looks infected
• If the skin is painful
• If there appears to be a reaction to any treatment
