Molluscum is an eyesore but not a big deal

Molluscum are little, round, usually blister like bumps that appear anywhere on the body and are common in children of all ages. Molluscum rash is due to a virus and like the viruses that cause warts, it’s hearty and can last a long time. Here are images of some typical lesions.

Molluscum cause a lot of consternation for parents in part because schools or daycares sometimes make a bigger deal out of it than it warrants. Molluscum appear out of nowhere and often spread locally around the first few lesions. Most of the time I see molluscum on the trunk ,but it can occur anywhere including the face and genitals. The molluscum virus is spread from person to person but much like the wart virus, but you usually need to be a susceptible host or have some irritation on the skin for the virus to glom on to in order to develop lesions. We will all be exposed to the virus and the vast majority of us clear the virus and develop immunity without ever getting the rash.

If you are one of the unlucky ones, though, who develops a rash, there are several options for managing it. I think the best option is to do nothing and wait it out. Even though it can take months (and sometimes a year or more) for the rash to resolve, you know you’ll develop immunity to the virus this way and be less likely to go on to develop the rash again when re-exposed. Sometimes when waiting it out, the rash will get red and irritated and even look like it’s getting infected. When this happens, it means the immune system is finally amped up and is getting rid of the virus. Within a week or so the rash will be gone once this inflammatory redness appears.

Sometimes, though, waiting it out is tough. Even though kids with molluscum can swim and play sports because the virus is ubiquitous anyway, some schools or pools may frown on kids with a lot of lesions participating. Parents too sometimes get impatient and want the lesions removed. There are a couple of over the counter treatment options to consider:

• Benzoyl peroxide can be helpful but it’s unclear how it works. It is easy and inexpensive. Use daily until irritation and inflammation appear and then stop and let the body finish it off. Scarring can occur though.
• Salicylic acid can be found in over-the-counter wart medications. Apply daily until inflammation or irritation appears. Again, scarring can occur.

If these don’t work and waiting it out isn’t an option, I send kids to the dermatologist for treatment because the remaining treatments tend to be painful and potentially scarring. The only benefit to treat is to shorten duration of lesions. Here are the therapeutic options:

• Destructive curettage: the area is typically numbed with a topical numbing cream and then a metal loop is used to scoop off the lesions. There is a risk of scarring and there’s a fair amount of local bleeding with this method.
• Cantheridin (beetle juice) can be applied which creates a blister which then destroys the skin in the area thereby destroying the lesion. Careful application is a must or you will get a ton of blistering. The child should wash it off at bedtime and then use Neosporin for several days.
• Liquid nitrogen can destroy the lesions too. But it hurts a lot, so numbing cream is needed.
• Tretinoin (Retin A) can be used as an irritant which incites the immune system to fight it or through the irritaion destroys the lesion but can cause severe irritation. This method should not be used if a child has eczema. Tretinoin is used daily until signs of inflammation appear and then you can stop and let the body finish the job.
• Imiquimod stimulates the immune system to resolve the rash. It’s not approved for use in molluscum (it’s on label use is for genital warts) but it works. It can cause severe irritation and is expensive though. It is used  3-5 times a week at night until inflammation starts and then stopped to let the body finish the job.

All in all, I am a big believer in just letting nature do the job when it comes to molluscum but it really can take a year or more. Knowing all the options makes sense, and understanding the pros and cons of each will help you make the best choice.