Section 5

This condition is a benign viral infection that appears as crops of discrete, slightly umbilicated, flesh-colored, or shiny papules. It is extremely common among children and may be seen in several children within a family. The lesions may become inflamed if traumatized or infected and sometimes become inflamed spontaneously as they resolve. Rarely is there only a solitary lesion; most commonly there are fewer than 20. However, the total number is sometimes in hundreds. The lesions tend to be grouped, and the average size of a lesion is 2–3 mm in diameter and height. The trunk, face, and genitalia are the most common sites of infection. Pruritus is an occasional symptom and may be the impetus for inoculating the viral infection from one area of the skin to another. Molluscum contagiosum is self-limited, but treatment is often required out of concern for appearance. Treatment should be individualized to the age and extent of involvement in each patient. Destruction of lesions with a sharp curette is the preferred mode in a cooperative child with limited disease. The child with numerous lesions poses a particular therapeutic challenge.

Figure 5–2

Occasionally, a lesion of molluscum contagiosum may grow to as large as 3 cm in diameter. Two such “giant mollusca” are pictured here. The diagnosis is usually suggested by the presence of more typical, smaller lesions on adjacent or distant skin surfaces. Treatment is again by surgical removal when possible. Local anesthesia would be a feasible and a kind thing to administer in such a case.

Figure 5–3

Many children with molluscum contagiosum infection develop an eczematous, pruritic dermatitis surrounding the affected area of involvement. Low potency topical corticosteroids can alleviate the dermatitis but these medications should not be used chronically. At times, the lesions in the involved area may have to be removed in order to permanently clear the dermatitis.

Figure 5–4

In some patients when the immune response to the molluscum virus occurs, a hypersensitivity eruption may be noted. This eruption favors the extremities, particularly the elbows (Fig. 5-5) and knees, with skin colored to erythematous papules and papulovesicles which may be grouped. The buttocks may also be involved. Inflamed molluscum is seen elsewhere. Note the inflamed mollusum on the abdomen in this figure.

Figure 5–5

The common wart is a benign growth caused by localized infection with one of the many types of human papillomavirus. These small DNA viruses are part ...

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