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Molluscum

Molluscum is a common skin problem causing small, harmless raised spots.The spots can be present for a few weeks to several months or more than a year. It is caused by the Molluscum Contagiosum Virus (MCV). This virus only lives in humans.  It is contagious and can be spread from person to person or to different areas in the same person. It can also be spread by children sharing baths or pools; by bath toys and on towels. Usually it does not need any treatment. Good personal hygiene can help prevent it spreading.

Signs and symptoms

At first the molluscum spots look like pimples. Then they become round, pearl coloured lumps that have a white mark or core in the centre of them.  They are usually between 1 to 5 mm in size, but can be as big as 1 - 2 cm wide. Usually they are on the nappy area, tummy, face, arms and legs. 

Molluscum spots usually heal without scarring, although a small 'chicken pox' type scar is possible. Scarring is slightly more likely with more aggressive treatment. Molluscum spots are painless but can be itchy - scratching can also cause scarring.

How is it spread?

Molluscum is spread from skin to skin contact when touching the molluscum lumps. Sharing towels and face cloths is another common way to spread the virus. Swimming in pools can also spread it to other children through the pool water. It can take weeks to months from when your child has contact with the molluscum virus to when the spots appear.

Treatment

Most of the time, Molluscum does not need any treatment. The spots usually disappear over a period of time as the body fights and kills the virus. A small number of children can have the spots for several months. 

No one treatment is effective for all children. More aggressive treatment may cause scarring and so it is best to try simple treatments first. Simple treatments are designed to irritate the spots. This is to encourage the body's immune system to recognize the virus and destroy the infected cells.  

1. Tape stripping
   Cover the spots with an occlusive tape such as duct tape or elastoplast. The tape is left on for 2 days and then pulled off. This irritates the spots. This may need to be done several times to try to remove the central core of the spot. Ensure the adhesive part of the elastoplast directly touches the molluscum, as simply covering the molluscum with a bandaid with not work.  Betadine may also be applied to the molluscum before applying the tape.
2. 'Irritating solutions'
   If tape stripping by itself is not effective, also applying an irritating solution such as Benzac gel (benzoyl peroxide 10%) or Retin-A (tretinoin cream) to the spots can help. The solution makes the spot become inflamed and needs to be applied carefully to avoid the surrounding skin.  The tape stripping then needs to be done each day. See your family doctor first.
3. Aluminium acetate (Burow's solution)
   If the above two steps do not work, a weak solution of aluminium acetate (Burow's solution) diluted with water (1 part Burow's solution and 29 parts water) can be gently dabbed on to the spots after the shower. Allow the solution to dry, then apply the Benzac or Retin-A and then cover with tape. Repeat once every day.
4. Remove the central core(older children only)
   In older children, squeezing or removing the central core may help to speed the disappearance of the spots. See your family doctor or dermatologist.
5. Liquid nitrogen freezing
   Liquid nitrogen is applied to the spots every 2-3 weeks. There is a higher risk of mild scarring. Please see your family doctor or dermatologist.
6. Other creams
   Other creams are available to treat Molluscum. There is also a slightly higher risk of mild scarring. Please see your family doctor or dermatologist.

Sometimes the skin around the lumps can get a rash like eczema and the skin can become infected with bacteria. Sometimes antibiotics are used for this skin infection. The antibiotics do not treat the molluscum spots themselves or the molluscum virus, they only treat lumps with virus and bacterial infection.  Sometimes the molluscum is treated because it is irritating your child and because it is easily seen by other people.

At home care

Strict attention to hygiene is very important. Children with Molluscum should do the following:

• Have a shower instead of a bath. The Molluscum virus can live and spread in the bath water to other parts of the body.
• Wash and dry any bath toys every day after use. Bath toys can spread the virus.
• Be careful drying your child dry after their shower. The virus can be spread on the towel - try to dry areas with the spots last. 
• Do not share baths with other children.
• Do not go into swimming pools until the spots have gone away.
• Do not share towels, face washers (flannels) or clothing.
• Wash your hands after touching the Molluscum spots.
• Children with Molluscum can go to school and play with other children, as clothing usually covers the affected areas.

Key points to remember

• Molluscum spots are caused by a virus.
• It is spread from person to person by touching the Molluscum. It is also easily spread through bath or pool water, bath toys and towels.
• It is not life threatening.
• The spots can last for weeks to months.
• Treatment is not always needed.
• Careful hygiene can help reduce the spread of the infection.
• The treatment is designed to irritate the molluscum causing it to become red and inflammed.
• The treatment may also irritate the surrounding skin.
• Molluscum contagiosum often causes a flare up of eczema, before and during treatment.

For more information

• See your local family doctor (GP)
• See your local pharmacist
• See your Child and Maternal Health Nurse
• Better Health Channel www.betterhealth.vic.gov.au

Individual instructions