molluscum contagiosum
Molluscum contagiosum is a common rash in early childhood, and I always love for parents to know what it looks like so that you know what to do (and why you don’t need to panic!).
what to know
Molluscum is a viral skin condition (often caused by a DNA poxvirus). it looks like this:
small (2-6 mm)
round (dome-shaped) with a central depression in the middle
smooth
firm
sometimes alone, sometimes in clusters
We call the round raised lesions “papules”, and they do have a characteristic appearance - that central umbilication, or divet, in the middle of the lesion.
Though you can see it anywhere on the body, it’s common on the trunk (chest and abdomen), arms, and sometimes the face. Molluscum is spread by direct skin-to-skin contact, sharing objects (sharing towels, toys, clothing, wrestling mats, etc.), and autoinoculation (when a child scratches and touches other parts of their body).
We do see it more commonly in children who have underlying eczema or sensitive skin, swimmers (it can exist in warm water), and those who are immunocompromised. Though its specific incubation period isn’t known, it may be anywhere from 2-6 weeks.
We can usually identify it clinically (you can do a biopsy to confirm, but it is mostly a clinical diagnosis).
One of the most important things to know about molluscum is that it’s generally benign and it can last for a while (from a few months to a few years) before it goes away. It does, for the most part, go away on its own. But let’s chat about if and when you might choose to treat it in your family.
what to do
Most molluscum in otherwise healthy kids eventually heals on its own without scarring. This is why we don’t treat it as a default. There are times when you can consider therapy: if it’s very distressing to your child, if they have eczema or other skin conditions that are exacerbating molluscum symptoms, if it’s spreading and leading to secondary bacterial skin infections, etc. In those cases, there are a few options for treatment.
Berdazimer gel: this is a topical nitric oxide-releasing agent approved for children 1 years old and older. You apply it daily to each lesion for up to 12 weeks at home.
Cantharidin: this is an extract from a blister beetle. It’s an effective and common way of treating molluscum for children 2 years old and older. It’s a solution that forms a thin film. It’s an in-office treatment — your provider (often dermatologist, some pediatricians do it in their offices) will apple a thin film to non-inflamed lesions. You’ll leave them uncovered after the visit, wash off the film ~1 day after they apply it, and then recheck in a month. It can sometimes blister up as a part of healing. This is not for facial lesions or lesions in the GU area. You can also see changes in skin pigment after treatment (hypo or hyperpigmentation), so make sure to talk with your care team if you’re considering this.
Topical tretinoin: low-dose t-retinoin may be trialed for facial lesions. the data is a little more mixed on efficacy (it has been variable), but you can chat with your care team for questions.
Liquid nitrogen (cryotherapy) or manual extraction: These treatments are often effective but are also painful and not well tolerated by many kids, so they’re not typically first-line. Cryotherapy can also cause changes in pigment, especially in kids with darker skin tones, so please remember to talk with your care team about this as well.
Sources:
Pera Calvi I, R Marques I, Cruz SA, et al. Safety and efficacy of topical nitric oxide-releasing berdazimer gel for molluscum contagiosum clearance: A systematic review and meta-analysis of randomized controlled trials. Pediatr Dermatol. 2023 Sep 18;. PubMed ID: 37721050
Hebert AA, Bhatia N, Del Rosso JQ. Molluscum contagiosum: epidemiology, considerations, treatment options, and therapeutic gaps. J Clin Aesthet Dermatol. 2023 Aug;16(8 Suppl 1):S4-S11. PubMed ID: 37636018
