Jill Irving has been a practicing health visitor for 33 years and left the NHS in 2011 to work independently. She has built a small private caseload, and also works with several international organisations. Jill is the health visiting expert for www.babycentre.co.uk who are recognised as the most complete on-line resource for expectant and new parents. Jill's work has been published by Babycentre.co.uk in 13 countries around the world. Jill has also had several articles published in professional journals.Molluscum contagiosum
There is nothing quite like the perfection of a young child's skin. So, understandably when any parent is confronted with the skin condition of Molluscum contagiosum this naturally causes concern.
What is Molluscum contagiosum?
Molluscum contagiosum is a highly contagious viral skin infection caused by the Molluscum contagiosum virus but thankfully isn't serious. It commonly affects children aged between one and five years. Although reported to be very common, as a health visitor I have only seen about two cases within the last year. My colleague who is a Nurse Practitioner at a busy city GP practice has seen a similar number. All cases have involved toddler aged children.
Like any condition the doctor or nurse needs to have a sound knowledge of Molluscum contagiosum before they can accurately diagnose it and advise the appropriate treatment. A few years ago my own son contracted Molluscum contagiosum but as both the family GP and I were unsure what it was the condition was never diagnosed appropriately. He was at school at the time and felt embarrassed and very self conscious and reluctant to undress either at home or at school for games.
So what does Molluscum contagiosum look like?
It appears as small, round, shiny, pearly white or pinkish spots. There are usually no more than about 20 of them and each pimple has a dimple in the middle or a tiny puss filled head. They are usually about 2.5mm wide and tend to grow in number over a few weeks. These spots are not painful but may be itchy. The spots will tend to appear on your child's chest and stomach or inside joints such as on their inner elbow and behind knees. However, they can break out almost anywhere including your child's face. Molluscum contagiosum usually clears up within 18 to 24 months without treatment. Although it does not generally cause scarring you may notice each spot leaves a small pitted mark.
Over a period of about 6-12 weeks, the spots tend to crust over before eventually healing. As the virus is highly contagious there is a high risk that it will spread to new areas of skin so new spots may develop as the old ones are healing. In about 1 in 10 cases of Molluscum contagiosum, a patch of eczema develops around the spots. If your child already has atopic eczema they will be particularly vulnerable to Molluscum contagiosum.
So why and how has your child become infected with the virus?
Most adults have developed immunity to the Molluscum contagiosum virus so this means that most of us will not develop it. So despite being a parent and in close contact with your infected child you should be fine. However, people with weak immune systems such as young children are at particular risk of infection. It can take between seven days and six months for the pimples to appear after your child has been in contact with the virus. It is not really known how long someone with Molluscum contagiosum is contagious for, but is generally thought to last up until the last spot has completely healed.
As the virus is highly contagious, it is easily spread among other young children at nursery and school while playing and sharing contaminated items, which could even be a toy. Consequently, there is a strong chance that is where your child has come into contact with Molluscum contagiosum.
What's the best way to treat Molluscum contagiosum?
Traditionally GPs and Practice Nurses have recommended that the best treatment is to do nothing. With older children it has occasionally been suggested squeezing or piercing the spots to remove the white matter inside them. Some GPs have also suggested using cryotherapy by freezing each pimple using liquid nitrogen. All these treatments can be painful; leave scarring and it may be upsetting for young children. For this reason I and other health visitors now recommend a topical treatment such as MolluDab, which contains 5% potassium hydroxide. MolluDab has only recently become available in the UK so some GPs, HVs or chemists may still not yet be fully aware of it.
Potassium hydroxide works by breaking down the skin cells around the virus, allowing the immune system to respond to it. The liquid is applied twice a day on each spot for around 4-6 days. The lesions should eventually become inflamed, before healing and disappear within 1-5 weeks. Compared to an 18 month wait for Molluscum contagiosum to normally subside, this comes as a much welcome relief for all parents. MolluDab is available on prescription from your GP or over the counter from your pharmacist.
As a parent is there anything else you can do?
It is really important that if your child attends a playgroup, a daycare setting or school that the staff is aware that your child has the condition. This will not only help prevent the spread but it will also help your child receive the correct care whilst you are not present. Your child will not need to stay away from nursery or school and can still continue with all sporting activities including swimming. However, your child should not share a bath.
Molluscum contagiosum thrives under warm and damp conditions, so keep your child's skin clean and dry. Try to avoid sharing family towels, clothing and bed linen. I would also recommend avoiding the use of all flannels, which tend to be constantly damp and if you have a busy family household it may be difficult to prevent other children from sharing them with their siblings. If at all possible try and also prevent your child from sharing their toys. If you think this is impossible, then they should be regularly washed in hot soapy water in an attempt to avoid further contamination.
Keeping your child's nails very short and whenever possible the spots covered will encourage your child not to scratch the infected area. Scratching can spread the virus to different parts of your child's body. It can also increase the risk of either family members or your child's friends catching the virus.
The good news is that once that your child's bout of Molluscum contagiosum has completely cleared; it is rare for it to return.