Molluscum contagiosum (viral warts)
Molluscum contagiosum is a very common viral infection in children that causes characteristic skin lesions.
How do you identify the typical lesion? Is there a reason to worry? What is the ‘BOTE’ sign? And is there a treatment?
What is the name of the virus and its family?
The virus that causes molluscum contagiosum belongs to the poxvirus family. Humans are the only known reservoir for this virus. Don’t confuse it with the papillomavirus, which causes a different type of wart in different areas of the body.
How does a characteristic lesion of Molluscum contagiosum look?
It is a small lesion, 1-5 mm in size, pearly white or pink in color, with a central dimple. It is typically found on the torso, face, or limbs, but any area of the body may be involved (except for the palms or soles of the feet). Sometimes, there may be redness around these lesions, indicating local inflammation.
How many lesions can you see in children with Molluscum contagiosum?
The number of lesions can range from one to twenty, usually in close proximity to one another. At times, the number of lesions can be much larger.
Who is more prone to this infection?
Everyone, but:
The most common age group is children between the ages of 2 and 6 years.
Children with atopic dermatitis are more prone to a more widespread infection.
Children with immune suppression may experience a more extensive infection that is resistant to treatment.
How do children get infected?
This infection is transmitted from person to person (from an infected child to a non-infected child) through direct contact—such as touch, rubbing, or scratching—or by contact with infected objects like towels or linens.
Once a child’s skin is infected, self-infection, also known as autoinoculation (contact with infected skin and transmission to another area), is common.
The incubation period (the time from infection to the appearance of lesions) is typically 2-7 weeks.
The biggest problem in otherwise healthy children is primarily cosmetic, as the lesions are sometimes found on exposed areas (such as the face), causing discomfort.
The second complication is itchiness and discomfort.
The third complication is a secondary bacterial infection. Bacteria found on the skin may infect areas injured by molluscum. When infected, the area will appear reddish, feel warm, and may sometimes produce pus. See the picture.
How will the doctor diagnose Molluscum contagiosum?
This is a clinical diagnosis based on the characteristic appearance of the lesions. No laboratory tests or biological swabs are required for diagnosis.
What are the complications of these viral warts in children?
The fourth complication is pitted scarring (see the picture in this link). This rare complication occurs less frequently after a spontaneous recovery from molluscum contagiosum, with no specific treatment. In most cases, the scarring will fade over time.
How long does it take for these lesions to disappear?
Usually, lesions disappear within 6 to 12 months. Sometimes, they can persist for up to a year and a half, and rarely, even up to 4 years. During this period, old lesions may disappear while new ones appear. In fact, the recovery process involves the activation of the body’s immune response against the virus. As an anecdote, in some cases, after months of a static situation, an inflammatory process begins in the area of these lesions, which is sometimes mistaken for a secondary infection. However, this is actually the start of the body’s immune response against the virus and the lesions, marking the beginning of the end, referred to as the ‘BOTE’ sign.
How can you prevent transmission among household members?
Molluscum contagiosum is indeed infectious, and it’s common to see several cases among children in the same family. The risk of transmission can be reduced by avoiding shared baths and towels. Children with molluscum can participate in normal activities at kindergarten or school. If the lesions are on exposed areas, especially if the child is itching or the skin is injured, it is advised to cover the affected area with a pad to prevent direct contact with the lesions.
So, if it will disappear, should we treat these warts?
.We want to emphasize again that the disease always clears on its own within months or years. However, treatment is available, and in some cases, it’s important to treat.
What are the purposes of treatment?
– Cosmetic
– Reduction of discomfort for the child (itchiness)
– Reduction of incidence of transmission to others and self
– Prevention of complications, mainly secondary bacterial infections
Who should be considered for treatment?
Treatment should be considered for children with many lesions that cause cosmetic discomfort (for example, many lesions on the face), social distress, or severe irritation. Cases with a secondary bacterial infection should be treated, usually with local antibiotics. Always remember that in healthy children, this condition is self-limiting, with or without treatment.
What is the treatment?
There is no consensus on how to treat this condition, and several options are available. Naturally, when there is no preferred “standard” medical option, different approaches may be used. If you have decided to treat it, for whatever reason, I advise consulting a pediatric dermatologist.
The common options are:
– Cryotherapy – Freezing the wart, usually using nitrogen. The treatment is not pleasant but not unbearable. The problem is that sometimes more than one treatment is required, and occasionally, lesions may spread beyond the area being treated (satellite lesions).
– Curettage – Using a special medical “spoon” to scrape the wart.
– Cantharidin – A toxin that was extracted from beetles in the past and is now manufactured synthetically. In response to a burn with this substance, a blister forms, which is later shed along with the wart. This treatment is not recommended for use on the face.
In summary:
To summarize, this is a common condition.
My child had over 50 lesions, all of which cleared without specific treatment.
In most cases, I recommend being patient. Instead of wasting time and money on unnecessary treatments, go have some ice cream!
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