Molluscum Contagium - Appalachian Spring Dermatology

What is molluscum contagiosum?
Molluscum contagiosum is a common skin disease caused by a virus (Molluscum contagiosum virus) causing flesh-colored bumps on the skin. The “contagiosum” implies that the virus is easily spread by skin contact. This virus belongs to the poxvirus family and enters the skin through small openings in the skin. It does not affect any internal organs.

What do molluscum look like?

Molluscum are usually small flesh-colored or pink dome-shaped growths that often become red or inflamed. They may appear shiny and have a small indentation in the center. Molluscum can spread by skin-to-skin contact. They are usually found in areas of skin that touch each other such as the folds in the arm or the groin. They are also found in clusters on the chest, abdomen, and buttocks and can involve the face and eyelids. Each bump has a core filled with thousands of viral particles.

How do you get molluscum?
The molluscum virus is transmitted from the skin of one person who has these growths to the skin of another person. It occurs most often in cases where skin-to-skin contact is frequent, in young children — especially among siblings, or in swimming pools. If growths are present in the genital area, molluscum can be sexually transmitted.

Who is most at risk to get molluscum?

People exposed to the molluscum virus through skin-to-skin contact have an increased risk of developing these growths. Children tend to get molluscum more often than adults. It is also more common in athletes such as wrestlers and swimmers, where there is a lot of skin to skin contact. In my practice, people are more likely to spread molluscum on themselves than spread it to other people.

Does molluscum contagiosum need to be treated?

Many dermatologists advise treating molluscum because the growths are easily spread from one area of the skin to another. However, molluscum will eventually go away on its own without leaving a scar. It usually takes 4-6 months for all lesions to resolve, but untreated, it can take over five years for all of the molluscum to go away. The decision to treat or not to treat is a personal one. The goal is not to traumatize a child with painful in-office treatments. However, untreated, a patient with a few lesions, often will have a few hundred before we know it. Having molluscum can cause social problems at school as kids are embarrassed or made fun of for having skin problems.

How do dermatologists treat molluscum?
Molluscum are treated in similar ways that warts are treated. They can be frozen with liquid nitrogen, destroyed with various acids or blistering solutions, treated with an electric needle (electrocautery), scraped off with a sharp instrument (curette), treated daily with a home application of a topical retinoid or salicylic cream or gel, a topical immune modifier, or other topical antiviral medications. If there are many growths, multiple treatment sessions may be needed every 3 to 6 weeks until the growths are gone. An option, especially with young children, is not to treat molluscum and wait for the growths to go away. The MAIN GOAL in treatment is to rev up the immune system. Once lesions start to get red and inflamed, that is actually a GOOD SIGN. When they are red and inflamed, that means the patient’s immune system is paying attention to the molluscum and trying to get rid of them.

Treatment of Molluscum

Although there are many treatment options, none are perfect. Most require many treatments over months. Dr. Rosenberger tends to take a less aggressive approach with the treatments below. The goal is to reduce the spread and not traumatize the patient while the immune system does eventually kick in and take them all away. DON’T PICK! The bumps are filled with viral particles which can easily reinoculate skin.

Applying cantharidin

Often, a solution called cantharidin (Cantharone or Cantharone Plus) is commonly used to treat molluscum. Cantharidin is a blister beetle extract that works by irritating a molluscum and forming a blister under the molluscum. The goal is to have the molluscum “peel off” with the blister roof. Please Note: Cantharone is not FDA approved and is purchased from a Canadian supplier. However, this is a common, safe, and minimally painful procedure used by dermatologists for many years. With this treatment, the doctor “paints” the chemical onto the molluscum. Most people don’t feel any pain when the chemical is applied to the molluscum. However, patients do experience some pain and blistering of the molluscum in about 3 to 8 hours. After treatment with cantharidin, a bandage is often put over the molluscum. The bandage can be removed at home once it peels off easily. If the molluscum isn’t gone after one treatment, they can be retreated. Again, the goal is to irritate or inflame a few of the molluscum to get the immune system to take them all away

Imiquimod

Imiquimod is a topical immunomodulator originally designed to treat genital warts. However, it is used for multiple other skin conditions, including treating skin cancers. It is applied topically at home EVERY DAY. Eventually, and by that, I mean weeks to months later, it helps the immune system kick in and fights off the virus. This is Dr. Rosenberger’s preferred method of treatment on the face or in other areas where scarring is of great importance.

Retinoids

Medications in the family of RetinA include tretinoin and adapalene (Differin). These medications can be applied daily with the point of irritating the lesion. This often makes the skin VERY red and angry, and most patients do not prefer this option. The point is to get it so irritated that the immune system works to take the virus away.
Other treatment options, including cryotherapy (freezing), curettage (scraping off), and laser, tend to be more traumatic and scarring, especially you young patients, so Dr. Rosenberger does not recommend these options.

There are multiple OTC regimens for sale online. We do not endorse using any of those in particular. Some things work for some people because the immune system is different for each of us. Beware of amazing “testimonials”; getting rid of molluscum can be a long battle and not for the faint of heart. Be patient. THEY WILL ALL GO AWAY!

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