Molluscum - Patients ask, Dr. Ringpfeil answers
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Molluscum contagiosum is a benign rash caused by a harmless pox virus. Small skin colored or pink bumps with a central dell can occur on various body areas in children but in adults are most commonly seen in the genital area. They are contagious and transmission is by skin to skin contact. They are usually asymptomatic but if irritated can become itchy, red and tender. Once they are red and tender, they tend to resolve within another 10-14 days.
The diagnosis is usually made clinically based on the characteristic appearance of molluscum contagiosum. A biopsy is rarely necessary unless lesions are unusual.
In children, asymptomatic lesions need not be treated because they will eventually resolve over the course of 9 to 12 months. If treatment is desired due to appearance or symptoms, a number of modal;ities may be employed. Application of the following over the counter and prescription substances may be effective: tea tree oil (including Zymaderm), sinecatechin (green tea), salicylic acid, podophyllin, imiquimod, topical retinoids and cantharidin,. At home treatments often require multiple applications and have the potential for irritation. Length of treatment is highly variable. Individual lesions can be treated in the office via cryosurgery with liquid nitrogen, via application of a chemical blistering agent called cantharidin (commonly referred to as blister beetle juice) or via pulsed dye laser. In-office treatments are highly effective in visible lesions. Some molluscum bumps are not noticeable at time of treatment and if they develop several days later may start another crop on the skin. Application of liquid nitrogen causes some discomfort due to its very cold temperature, whereas cantharidin application is painless. Both treatments can leave permanently lighter colored marks. The pulsed dye laser causes an intense rubber band snapping sensation but leaves no scar. In sexually active adults, the molluscum lesions should be treated to avoid transmission to others. Cryosurgery is usually the treatment of choice in the genital area however topical imiquimod cream or sinecatechin ointment can be employed. Lesions can also be physically removed via curettage (scraping) but this method is less commonly employed. Sexual partners should be checked for the presence of molluscum lesions to avoid reinfection.
If the decision is made not to treat molluscum lesions in children it is important to avoid irritation to the molluscum. Scratching and chronic friction can cause mollsucum to become inflamed, red and sore. A water proof bandaid may be applied to single spots especially if molluscum is located in exposed or easily scratched area. The molluscum lesions themselves usually do not itch but they commonly occur in areas of eczema prone skin. They are also known to flare eczema (atopic dermatitis).Keeping a child's eczema or atopic dermatitis under control may lessen his or her risk for development of molluscum.
Molluscum are spread by skin to skin contact. Infected individuals should avoid skin to skin contact with others. Parents should not bathe their children together if one child has molluscum. Single lesions in exposed areas may be covered with a waterproof band aid that is renewed daily.