Molluscum contagiosum

Introduction

Molluscum contagiosum is a common viral skin infection of childhood that causes clusters of epidermal papules which are usually benign and self-limiting. They mostly arise in warm places, such as the armpit, behind the knees, groin or genital areas and on the lips.

Molluscum contagiosum tends to be more extensive and lasts longer in children who also have atopic eczema. Presentation to a doctor is often prompted by the development of eczema on the surrounding skin. It can be very extensive and troublesome in patients with underlying immune dysfunction.

Most cases resolve spontaneously within 6-9 months, but lesions can persist for more than a year.

Complications of molluscum contagiosum can include secondary bacterial infection and scarring related to pruritis and subsequent excoriation. However, often when the molluscum become inflamed and irritated this is a sign that the body is clearing the virus.

Children with molluscum contagiosum should not be isolated or restricted in their activities. Avoiding the sharing of towels and bathing together may reduce spread to siblings.

Pre-referral investigations

• Clinical examination is usually enough to diagnose molluscum contagiosum

Pre-referral management

General measures:

• Keep nails short and hands clean to avoid auto-inoculation by scratching
• Avoid sharing towels, clothing or other shared items
• Avoid sharing baths
• Keep papules covered with clothing or bandages to avoid spreading to others

Specific measures:

• Most of the time no treatment is required
• Eczema surrounding molluscum lesions should be treated with an appropriate strength and formulation of topical corticosteroid - refer to Eczema Pre-referral guideline.
• Medical treatments including tape stripping can be effective but is often painful
  • Put medical tape on the molluscum and then remove quickly, resulting in removal of the central umbilicated area
• Over the counter wart paints (that include salicylic acid) can be used effectively to initiate an immune response to the molluscum
  • Treat small areas of molluscum lesions at a time and protect the surrounding skin by applying petroleum jelly around the periphery of the area to be treated
• Physical treatments are occasionally used, including cryotherapy or gentle curettage
  • Scarring may be worse following these treatments than with conservative management

When to refer

If there are ongoing signs or symptoms which remain problematic despite the above management, please refer to the Dermatology Department.

How to refer

• Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
• Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals are made via the PCH Referral Office
• Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call PCH Switch on 6456 2222 to discuss with the Dermatology registrar.
  • The Dermatology Registrar at Perth Children’s Hospital is available between 8.30am and 5.00pm, Monday to Friday for the discussion of any patient management or dermatology queries.

Essential information to include in your referral

• Duration of molluscum
• Site(s) of lesions
• Previous and current treatment

References

1. Oakley, A 2015, Molluscum Contagiosum, viewed 30 March 2020, https://dermnetnz.org/topics/molluscum-contagiosum/
2. Dunlop, K 2019, Molluscum Contagiosum, viewed 30 March 2020, https://www.dermcoll.edu.au/atoz/molluscum-contagiosum/

Useful resources

1. Molluscum Contagiosum - Healthy WA
2. Molluscum Contagiosum - Dermnet NZ

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