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Why does my child keep getting molluscum?

Molluscum contagiosum is a viral infection in the skin.  The mechanism is similar to viral warts or veruccas with the pox virus causing the lesions.  Molluscum contagiosum is a common paediatric dermatological condition as the virus is easily spread via direct skin contact between children at school.  The virus can also be spread by sharing towels or clothing.

The typical lesion of molluscum contagiosum is an umbilicated papule.  The lesions tend to be pale or skin coloured and have a pearly appearance with a dimple in the centre.  They tend to occur in clusters and each papule may be of a slightly differing size.  Common places for them to occur in children are the flexural regions such as the armpits, knees and groin and also the hands.
Whilst parents are often told that these are harmless lesions that do not require treatment as they will eventually resolve spontaneously, Dermatologists will tend to be proactive with the treatment of molluscum contagiosum as the lesions can multiply, cause scarring, be itchy and uncomfortable for the child, and the lesions can become secondarily infected.

The first point of treatment is to implement some good housekeeping measures.  Ensuring one child does not pass the virus on to his or her siblings is important so towels and clothes should not be shared, and they should be washed in hot water.  As the pox virus can be transmitted in water, it is better for children to have showers where the water is constantly running of their skin rather than baths.
One of the most effective means of treating molluscum contagiosum is to de-roof each lesion using a hypodermic needle.  This extracts the molluscum body which is a small white pearl in the centre of the lesion which is where the virus is concentrated.  This can either be done by a Dermatologist in clinic, or the Dermatologist can show parents how to do this at home.  With multiple lesions I recommend treating three to four lesions each day.  For very young children this can be done whilst they are asleep.  Cryotherapy (liquid nitrogen) is sometimes used, however I find de-roofing more effective as cryotherapy can also leave hypopigmented patches.  Once the molluscum bodies have been extracted each individual lesion heals.

Another home treatment is the application of MolluDab, a 5% potassium hydroxide solution, which has recently become available in the United Kingdom.  This solution should be applied twice daily until the individual lesions show persistent inflammation at which point the healing process has commenced.  The treatment can be ceased and the papules should continue to involute.

If your child is getting recurrent molluscum contagiosum lesions then it may be that they are being re-infected at school or they may have a few lesions remaining on their body and they are self-inoculating.  Once a child has had molluscum contagiosum they should theoretically have some immunity to further infections however we do see children that get recurrently infected.  This is more likely in children with atopic dermatitis who have an abnormal skin barrier function.

Adults can also get molluscum contagiosum which may be on the hands if they are looking after children  The more common mode of transmission from adult to adult is through sexual contact.  These lesions are treated in the same way as in children.

You can find out more about treating molluscum contagiosum here.

Dr Martin Wade, Dermatologist at The London Skin and Hair Clinic.

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