Editors

AlexanderSalava

Molluscum Contagiosum

Lesions disappear spontaneously without treatment. If a cooperating child has just a few papules, healing can be speeded by mechanical means.

Molluscum contagiosum is common in children, particularly in those with atopic dry skin (picture 1). Apparently the development of specific immunity prevents recurrence.
There is no reason for limiting contacts with other children because of an innocent common virus, and the child can attend day-care or school normally.
Papules sometimes occur in adults. Numerous papules may be a sign of immunodeficiency.

Typical lesions presenting as small papules (of a few mm) with dimpling in the centre (picture 2) cause no problems as regards differential diagnosis, particularly when they are numerous.
In a very early stage the typical features may be lacking, and a single papule may be difficult to identify (picture 3). In an adult patient it may resemble an early basal cell carsinoma or sebaceous gland hyperplasia (picture 4).

There is no strong evidence on any treatment method. Often the best choice is to monitor spontaneous healing (usually within months).
Treatment may be attempted after case-by-base consideration.
Active treatment of the first few papules may stop the spread of the disease. The simplest treatment is to break the papule with special forceps, a needle, or curette. In a fearful child local lidocaine/prilocaine cream for 20-30 min before the procedure ensures adequate anaesthesia Lidocaine/Prilocaine Cream as a Local Anaesthetic for Curettage of Molluscum Contagiosum Lesions. Its application on of large areas of the skin is not recommended. Cryotherapy has also been used (liquid nitrogen being the most effective) but it is not totally painless either.
In adults treatment by curettage or cryotherapy without anaesthesia is an adequate treatment. Remember the possibility of HIV infection.
Various topical or systemic treatments for molluscum infection have been tried, but their efficacy is uncertain Interventions for Cutaneous Molluscum Contagiosum.
Some evidence is available regarding the efficacy of 5-10% potassium hydroxide solution (Nopoxivir^® ). The papules are wiped with the solution 1-2 times daily until they show signs of inflammation (takes a few weeks). Can be used in children over 2 years of age.
Appropriate treatment of eczema with corticosteroids and emollients does not compromise the healing of lesions, and it helps the patient.

If all lesions become irritated and eczema develops around them the probable cause is the onset of an immune response and not a bacterial infection.
If pyoderma develops it should be treated with antibiotics. In practice, true pyoderma are seen rather rarely.

There is no real indication for specialist consultation. The general practitioner can treat all lesions.