Clinical Practice Guidelines


  • Background

    Molluscum is a common viral infection of childhood it is usually a benign and self limiting infection of the skin. Spread is by direct contact, including auto-inoculation. The incubation period is unknown. A child may develop a few or a great many lesions. Most cases resolve spontaneously within 6-9 months, butlesions can persist for more than a year.


    Characteristic clinical features:

    • Firm, pearly, dome-shaped papules with central umbilication. Lesions are usually 1-3 mm in diameter, but can grow to 1-2 cm.
    • Presentation to a doctor is often prompted by the development of eczema in surrounding skin. Recognition can be difficult as these changes can obliterate the primary lesions, however a carefully taken history of the initial lesions is usually diagnostic.
    • Lesions can occur anywhere, particularly in flexures and areas of friction. Lesions may occur in the anogenital region and are not usually associated with sexual abuse.
    • Molluscum on eyelid margins can cause chronic conjunctivitis, often unilateral.
      Molluscum around eyes   Molluscum picture

    Links to other pictures


    The treatment depends on the age of the child, the location of the lesions and any secondary changes.

    • Most children do not require treatment. Complete resolution will happen when an immune response develops, which may take from 3 months to 3 years.
    • Secondary eczema should be treated with an appropriate topical steroid (e.g.mometasone furoate 0.1% (Elocon) under medical supervision). Use sparingly for short periods of time.
    • Individual lesions can be removed by cryotherapy or curettage, with or without topical anaesthesia.
    • These methods are usually not appropriate for younger children.
    • Other treatments may stimulate the immune response:
      • benzoyl peroxide 5% daily to small areas and covered with the adhesive part of a dressing.
      • aluminium acetate solution (Burrow's solution 1:30) for large areas
      • imiquimod 0.1% cream (expensive and evidence to support its use is limited)

        Note: Scarring may be worse following these treatments than with conservative management.

    • Lesions often become inflamed but antibiotics are rarely necessary.
    • Children with molluscum should not be isolated or restricted in their activities. Avoiding sharing towels or bathing together may reduce the spread to siblings.

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