Treating A Child With Multiple, Mildly Pruritic Papules

By Gary “Dock” Dockery, DPM, FACFAS

   Clinicians may also remove molluscum contagiosum lesions by curettage and one can gently scrape the lesions off. Adolescents and adults usually tolerate this well without anesthesia. However, some patients, especially younger children, complain that the curettage process is very uncomfortable and are less agreeable to this type of treatment as compared to cryotherapy. One may apply Emla® (AstraZeneca, lidocaine 2.5%, prilocaine 2.5%) cream 30 to 45 minutes prior to curettage to reduce the amount of discomfort during the procedure. Once one has removed the lesions, the patient can apply a topical antibiotic until the area heals.

   A variety of caustic agents have been shown to be effective in the treatment of molluscum contagiosum. Podophyllin, trichloroacetic acid, silver nitrate, potassium hydroxide, salicylic acid, urea and lactic acid may all be too harsh for younger children. One option is applying salicylic acid (17%) in collodion daily until an inflammatory response occurs. Other methods of treatment I have employed are daily application of products containing urea 50% gel (Keralac®, Doak) or lactic acid 10% cream (Lactinol®, Pedinol), which is applied twice a day. This process is less caustic and the parent can do it at home.

   Imiquimod topical 5% cream (Aldara®, 3M) is reportedly useful in removing multiple lesions of molluscum contagiosum. One can apply the cream sparingly to each lesion three times a week for eight to 12 weeks. No cover is necessary during treatment. This form of treatment is relatively expensive in comparison to the other treatments and may not have any additional benefits in the long run.

In Summary

Molluscum contagiosum are benign lesions that one may mistake for warts or other conditions on the lower extremities. They present with a typical clinical appearance and one can remove them with cryotherapy, curettage or other topical techniques. Advise patients that these are benign but contagious lesions. Also advise them to have a periodic skin examination to prevent recurrence of the infection.

   Dr. Dockery is a Fellow of the American College of Foot and Ankle Surgeons, and the American Society of Podiatric Dermatology. He is board certified in foot and ankle surgery. Dr. Dockery is the Chairman of the Board and Director of Scientific Affairs for the Northwest Podiatric Foundation for Education and Research. Dr. Dockery is the author of Cutaneous Disorders of the Lower Extremity (Saunders, 1997) and Lower Extremity Soft Tissue & Cutaneous Plastic Surgery (Elsevier Science, 2006).

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