Download Molluscum Contagiosum

Molluscum Contagiosum
What causes Molluscum?
Molluscum are smooth, pearly, flesh-colored skin growths caused by a large brick-shaped
poxvirus. They begin as small bumps and may grow as large as a pencil eraser. Many have
a central pit where the virus bodies live. Usually, molluscum are found on the face and
body, but they may grow in the mouth, eye or other parts of the skin. Molluscum can be
itchy and a red, scaly rash can form around the lesions "molluscum dermatitis". When the
skin becomes red, scaly, or is scratched, it may become infected. The bumps usually last
from two weeks to one and a half years, and can go away by themselves. The molluscum
may be passed from child to child by direct contact.
Treatment:
Although molluscum will eventually resolve, lesions spread easily, may become infected,
may be itchy or irritated, and are sometimes cosmetically objectionable. For these reasons,
they are often removed. However, the goal should always be to avoid permanent scarring or
severe discomfort in treating this benign and usually transient condition. The treatment
depends on the age of the patient and the size and location of the growths:
1. Retin-A: Apply to each bump with a cotton tipped applicator once a day for several
weeks. If irritation is severe, stop treatment for 1-2 days and then resume if necessary.
2. Cantharone is a blistering agent made from beetles. It is applied with a wooden
applicator to the skin growth. A small blister is likely to form in a few hours after the
application. Whether blistering occurs or not be sure to wash the cantharone off in 4
hours (or sooner if blistering occurs early). When the scab falls off, the growth is
usually gone. This treatment is useful because the application is not painful but it is
used carefully and selectively on the face and in skin creases, where "satellite blisters"
and erosions may develop. Rarely children can be quite sensitive and extensive
blistering is seen. Although the blisters are uncomfortable, they are very superficial and
resolve within a few days. Compresses with lukewarm warm water and Tylenol or
ibuprofen may be helpful.
3. Liquid nitrogen is applied with a special canister or cotton tipped applicator. It may
sting for a moment and then may form a blister or irritation at the site.
4. Destruction by scraping or “curetting” the bump. This form of treatment is usually
reserved for larger lesions which do not respond to the above therapies. This will
01/03
usually be performed only after the lesion is numbed with a topical anesthetic cream that
is to be applied at home. A prescription will be given prior to the appointment.
5. Imiquimod 5% cream (Aldara) is an agent which affects the patient's immune system,
or infection fighting abilities, and is helpful in some cases. The cream acts by
stimulating skin cells to produce Interferon and other virus-fighting proteins. The cream
is not yet FDA approved for use in children less than 12 years of age, but is often used
"off-label” in children for the treatment of both warts and molluscum. The medicine
can cause significant irritation in some children, and for that reason we usually start
treatment at three times a week, increasing slowly to daily application daily as tolerated.
Occasionally occlusion of the area with tape or a Band-Aid is required, but irritation is
more likely when the site is covered.
6. Cimetidine is an oral agent which is most commonly used to treat stomach ulcers. One
study has shown that it can be helpful in the treatment of molluscum. This drug is
reserved for children who have many lesions which do not respond to standard therapy.
It is generally given three times a day by mouth for 6 to 8 weeks. Headaches and
diarrhea occasionally develop while on treatment.
Because one liquid nitrogen treatment does not usually completely remove the wart, we often
recommend topical treatments following liquid nitrogen therapy however you should not start
these treatments until the site can tolerate them. Wait at least 3 days after liquid nitrogen therapy
has been used, or wait until the blister has healed over (often 5-7 days).
This is the medical opinion of Savannah River Dermatology. For additional
information, please contact our office at 706-691-7091.
01/03