Bubble Trouble

DISCUSSION
One of the most frequently encountered skin lesions in primary care, molluscum contagiosum (MC) is seen mostly in children. It is strongly associated with immune suppression, especially atopy, which affects around 20% of newborns. Commonly called “water warts,” MC lesions have no connection to human papillomavirus and are instead caused by the molluscum contagiosum virus—the largest virus to infect humans.

This virus is transmitted through direct contact with an infected individual, which often occurs during the summertime when many children swim. Though the warts cause little if any harm, they can be a source of embarrassment for the child and can be concerning to parents, who are often given erroneous information about the diagnosis.

There’s also the unfortunate fact that the occasional MC lesion fills with pus, turning red and swollen—a fair imitation of bacterial infection. This is simply a sign that the lesion is dying and will soon disappear, but it’s understandably frightening to parents.

As this case illustrates so well, destroying a few MC lesions does nothing to keep a whole new crop from taking their place. And although the condition is self-limiting, it is common for the warts to take two or more years to go away.

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The truth is, to date, there has been no proven, safe, painless, effective treatment for MC. Modalities include laser, electrodessication, and simple curettage.

A new treatment that combines dilute povidone-iodine with dimethyl sulfoxide in an OTC compounded liquid mixture (applied bid) has shown some promise in limited trials (Capriotti et al. J Clin Aesthet Dermatol. 2017;10[3]:41). This is what the case patient was treated with. I have given it to perhaps a dozen patients over the past several months, but to date, none have returned to report results. (This, as far as I know, is not a proprietary product and I have no financial interest in it.)

TAKE-HOME LEARNING POINTS

• Firm, 2- to 3-mm, umbilicated papules on children are almost certainly molluscum contagiosum (MC), usually related to atopy.
• MC is acquired by direct contact but can be spread by scratching or picking.
• It often appears admixed with eczema, especially in the antecubital and popliteal areas.
• Although MC eventually resolves with or without treatment, the process can take a while, making patient/parent education important.
• The newest treatment (that I am aware of) is a mixture of povidone-iodine and dimethyl sulfoxide, to be applied bid.