I had a conscientious mom “up in arms” about her daughter having two molluscum lesions on her neck. I calmed her a bit and then discussed the treatment options with her. . .

Molluscum is a poxvirus causing a chronic localized infection.  The lesions are firm, flesh-colored, and dome-shaped.  It is considered common, with 5% of US children having molluscum.  Those with eczema may get molluscum easier.  Molluscum also affects healthy adolescent and adults, often from sexual contact or contact sports.

The poxvirus transmits from skin-to-skin, although it has been shown to transmit by towels or sponges and, rarely, in pool water. Humans are the only host and takes usually 2 to 6 weeks from contact until first lesion forms. In sexually active adolescents or adults, STD screening should also be performed.

There is a decision to make: to treat or not.  Adolescents and adults should be treated so as to avoid spread.  But for children, we can advise that molluscum is not harmful and will go away on its own (although this will take months.) A systematic review in 2009 showed “insufficient evidence to conclude that any treatment was definitively effective.”

That means that I do not push children to have treatment.

I do offer the following. . .

• Cryotherapy otherwise known as (“freezing”). Cons: painful to young children, may cause scarring and decreased skin pigmentation where frozen.
• Curettage (scooping out the dome-shaped lesion). Pros: 80% worked after a single session. Cons: fails more often with more lesions and with a history of eczema, may cause small depressed scar
• Cantharidin (a liquid blistering agent). Requires skill of physician placing the liquid. Repeat applications every 2 to 4 weeks commonly needed. Can cause scarring.

To avoid spread, cover lesions with clothing or bandages while at sleepovers and during contact sports.

To treat or not to treat? That is the question. . .