Eczema Complications series – Molluscum Contagiosum

This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!

Molluscum Contagiosum (Virus)

Apart from molluscum contagiosum, the other common viral infection is eczema herpeticum. This eczema complications series will not include herpeticum because it has been covered in April 2012 post: Eczema Herpeticum – What is it and is it Dangerous? Eczema herpeticum is caused by the herpes simplex virus and eczema children’s skin (being defective) is more vulnerable to the penetration of the virus.

The other common viral infection in children is molluscum contagiosum, caused by the molluscum contagiosum virus, a family of the pox virus. It appears in clusters of small bumps (papules) in places such as armpit, face, neck, abdomen, groin, joints which are warm and moist. The papules may be pink, white or brown but often with a center hole and waxy/shiny look. The papules will later turn inflamed, crusted or into scabs. The extent of the molluscum varies – from mild with a few papules in most healthy children to extensive and last longer for children with eczema (study here) or low immunity (for instance, larger and more papules in HIV patients). In healthy children, the virus will stay on the skin and not circulate in the body therefore the virus leave the body with full resolution of the papules.

Spreading of Molluscum Contagiosum

Molluscum Contagiosum is spread by skin contact, for instance, taking shower or swim together (not clear whether the water spread the virus or contact with towels, surfaces at pool spread the virus). It can also be spread via bedding, toys, towels and clothes. In adults, it can be spread by sexual intercourse. Children (age 1-4, some reports show up to 12) living in tropical climate (warm, humid, crowded) have a higher risk of molluscum contatgiosum. The incubation period ranges from weeks to months. The recovery period on its own can take from 6 months to few years. It follows that if you are infected, to limit sharing of towels, toys and touching surfaces (bandaged the papules).

Treatment of Molluscum Contagiosum

Treatment can be hastened by pinching/ squeezing the molluscum lesions to express the soft white core. This is best done a few lesions at a time for children as it can be painful. The base is then treated with silver nitrate or mild sclerosing agent. Various medical treatment may include electrocautery, cryotherapy (freezing), curettage (cutting), laser, cantharidine, imiquimod cream or wart cream containing salicylic acid. There is no drug/ vaccine that kill the virus. Consultation for treatment should be about 3-4 weeks apart as certain molluscum may have been in incubation stage.

Although both the molluscum contagiosum and small pox are pox virus, they are distinctively different to our immune system and thus a smallpox vaccination does not prevent molluscum contagiosum.

Relationship with Eczema

It is almost like a double-whammy – children with eczema with defective skin barrier are more susceptible to molluscum contagiosum and after getting molluscum contagiosum, the eczema worsened PLUS the molluscum at the eczema area healed slower. Furthermore, molluscum contagiosum is likely to be more extensive in eczema children due to the scratching of the papules, followed by touching the rest of the body. There is also linkage between molluscum contagiosum and long-term use of glucocorticoids which are steroids such as prednisone, dexamethasone and hydrocortisone. Use of non-steroid cream such as topical immune-modulators (tacrolimus and pimecrolimus) have also been associated with molluscum contagiosum (here).

My take – a lot of the complications are possibly going to be linked to scratching, where infection and bacteria/virus spread from one part to another. Therefore, it always make sense to treat eczema and take steps to improve the skin barrier.

Have your child had molluscum contagiosum before? Share your experience and it may help another family, thanks!