See also

Eczema           

Key points

1. Molluscum Contagiosum Virus (Molluscum) is a common viral infection of childhood that causes a self-limiting infection of the skin
2. Investigations are not required and most children do not require treatment
3. Most cases resolve spontaneously within 6-9 months, but lesions can persist for more than a year. Exclusion from day care or school is not required
4. Development of eczema in the surrounding skin is common and should be treated with usual eczema management

Background

• Molluscum is a common viral infection of childhood that causes a benign and self-limiting infection of the skin
• Lesions can occur anywhere on the body and a child may develop a few or many lesions
• Molluscum is spread by direct skin-to-skin contact, fomites (eg towels) or auto-inoculation by scratching or touching a lesion

Assessment

The diagnosis of Molluscum is made clinically by characteristic appearance of the lesions:

• Firm, pearly, dome-shaped papules with central umbilication (pit)
• Lesions are usually 1-3 mm in diameter, but can grow to 1-2 cm
• Lesions can occur anywhere on the body. The most common areas include the trunk, axillae, antecubital and popliteal fossae and groin. Auto-inoculation is responsible for most anogenital lesions in children

Complications:

• Eczema may develop in the surrounding skin. Recognition of Molluscum can be difficult as eczema can obliterate the primary lesions, however a carefully taken history about the appearance of the initial lesions is usually diagnostic
• Molluscum on eyelid margins can cause conjunctivitis (often unilateral)

Management

• Most children do not require treatment
• Exclusion from day care or school is not required
  • Children with Molluscum should not be isolated or restricted in their activities
• Avoiding sharing towels and bathing together may reduce the spread to siblings
• Complete resolution will happen when an immune response develops, which may take from 3 months to 3 years
• Treat secondary eczema
• Lesions often become inflamed (erythematous and swollen) but antibiotic treatment is not needed
• Individual lesions can be removed by cryotherapy or curettage, with or without topical anaesthesia
  • These methods are usually not appropriate for younger children
  • Scarring may be worse following these treatments than without treatment
• Cantharidin is a topical blistering agent that does not cause scarring
  • Refer to specialist dermatology services for consideration of Cantharidin treatment

Consider consultation with local paediatric team when

• The diagnosis is uncertain
• Severe secondary eczema

Parent information

Kids Health Info: Molluscum

Last updated December 2020