What are the clinical features?
There are many similarities between molluscum and warts. However, molluscum lesions are smaller, have a central dimple, and appear in groups.
Lesions are usually clustered in groups – anything from 2 to over 30. Numerous small lesions may appear close together and look like a rash. The lesions are usually smaller than viral warts (1 to 6mm across) and are classically described as ‘dome shaped’. If you were to use a magnifying glass and take a close look at the top of each lesion, you will often see a small dimple.
The lesions are skin-coloured, pink, red or brown, and are often a little shiny.
Individual lesions disappear after a few weeks – often to be replaced by new ones elsewhere. As the lesions begin to clear up, they can become inflamed and may even appear infected, though this is rare. The virus can also cause localized eczema in around 10% of people where the background skin becomes scaly.
Molluscum lesions can occasionally be up to 1.5cm. A solitary giant molluscum in an adult may look like a skin cancer, and a skin biopsy will likely be required.
Gallery of Molluscum
Please click on the images for details.
Usually, no treatment is required simply because:
- There is no treatment that is both easy and very effective
- Treatment is focused on individual lesions (like normal warts)
- Individual lesions clear up on their own in a few weeks
- Treatment does not stop lesions appearing elsewhere – so you can go to the effort of sorting out a couple of lesions only for another 2 to spring up somewhere else
In sensitive areas or on the face, most adults or parents of children would prefer lesions to be removed. The treatment may be divided into home treatments, and clinic treatments.
Home treatment with topical creams does not have a great evidence-based. The idea is to apply a topical cream or gel that irritates or gently inflames the skin and kick-start the immune system into getting rid of the virus early. Topicals include Potassium hydroxide 5% (not easily available in Australia) and Benzoyl Peroxide Cream (usually used as an acne preparation).
Self-treatment by expressing the contents of each molluscum may be considered in older kids or adults. Doing this after a bath or shower may be easier because the skin will be softer. You can use tweezers that you have previously sterilized with boiling water. Another alternative is to use a sterile pin. Be sure to use gloves to avoid spreading the virus to yourself or another part of the body. This treatment may be painful and does not have a strong evidence base. This option is only suitable for adults or older children who are really motivated to remove these themselves.
Clinic Treatments are more effective and include Imiquimod Cream (prescription-only) & Curettage (this requires a local anaesthetic). Cryotherapy (Freezing treatment) is the most widely used treatment in a medical clinic.
It should be emphasized that the majority of people or children require no treatment at all.
How long do they take to clear up?
The good news is that molluscum clears up on without any treatment. Individual lesions clear up within 2 months.
The whole episode, from beginning to end, is usually under 12 months (typically 6 to 9). The condition rarely takes a year or two to resolve.
Are any Precautions needed?
It is sensible to avoid sharing towels or sharing a bath. Scratching may pass the virus onto another part of the body – so try to avoid scratching! For troublesome itching, a steroid cream may help.
Children may swim, attend daycare or school without any worries.
Guidelines do not require lesions to be covered but if your child has very few lesions in an exposed area then you may wish to cover with a bandaid.
Here is a good Australian government health link for ways to prevent spreading molluscum.