What is this infection and how is it transmitted?
The causative agent is a virus from the group of poxviruses, which infects only humans and multiplies exclusively in epidermal cells. It does not penetrate the blood, does not affect internal organs and does not cause general malaise: there is no fever, weakness or enlarged lymph nodes in an uncomplicated course. Everything that happens is limited to the upper layer of the skin, and that is why the disease, despite its contagiousness, is considered benign.
Infection requires contact. The virus spreads from skin to skin during games, hugs, sleeping together, wrestling and other types of close contact between children, as well as through objects: towels, washcloths, toys, sports mats, bumpers and inflatable rings. Moisture facilitates transmission, so swimming pools and shared baths are known risk factors, and it is not the water itself that is contaminating, but wet shared surfaces and towels. From the moment of infection to the appearance of the first nodules, it usually takes from two weeks to several months, and sometimes up to six months, so it is almost impossible to establish the source.
- Direct skin-to-skin contact is the main route in children
- Shared towels, washcloths, sponges, bath accessories - a very common mechanism in the family
- Swimming pool, water park, sauna, wrestling mat, inflatable toys and circles
- Self-infection when scratching: the virus is transferred to neighboring areas, and the rash follows characteristic paths
- In adults, when localized on the pubis, genitals, inner thighs and lower abdomen, transmission through sexual contact is likely
- Children with atopic dermatitis become infected more often and stay sick longer: the skin barrier is compromised, and scratching spreads the virus
What does it look like
The nodule of molluscum contagiosum looks so characteristic that to an experienced doctor the diagnosis is usually clear at first glance. This is a hemispherical dense formation ranging in size from a pinhead to a pea, smooth, shiny, flesh-colored, pinkish or pearlescent, with a small depression in the center, similar to a navel. When pressed, a whitish, mushy mass is released from it.
- The number of elements is usually from several pieces to two or three dozen; with impaired immunity there can be hundreds of them
- Favorite places for children are the face, neck, torso, armpits, elbows, hands
- In adults, more often the lower abdomen, pubis, inner thighs, genitals
- The elements usually do not hurt; itching does not always occur and is more often associated with concomitant dermatitis
- Redness and peeling often appear around the nodules - this is the so-called dermatitis around the mollusk, and it may be the first sign that the immune system has begun to cope
- Before self-resolution, the nodule often becomes red, inflamed and looks like an abscess - this is an expected, not an alarming phase
A special situation is location on the eyelid or at the edge of the eyelashes. Such a nodule can cause persistent conjunctivitis, which does not respond to ordinary eye drops, because the reason is not in them, but in the constant flow of viral contents into the eye. In such cases, removal of the element is required, often together with an ophthalmologist, and it is useless to treat conjunctivitis alone.
It will go away on its own - but how long to wait?
Spontaneous resolution is the rule, not the exception: in a child with normal immunity, the nodules eventually disappear completely and without scarring. The timing, however, disappoints parents: most often it takes from six to eighteen months, and with constant self-infection, the process stretches for two to four years, because some elements disappear while new ones appear nearby.
- An individual nodule lives on average for about two to three months, but during this time it manages to sow neighboring areas
- Complete resolution of all rashes usually occurs within 6-18 months.
- With atopic dermatitis and constant scratching, the time period is extended.
- After the elements disappear, no scars remain; a temporary light or dark spot disappears within a few months
- Previous infection does not provide lasting protection, re-infection is possible
- It is not possible to speed up the process by “strengthening the immune system”, vitamins and immunostimulants - there are no proven means of this kind
Hence the informed decision. If a child has several nodules in closed areas, they do not interfere, the skin is healthy, and there are no other children in the family, it is quite reasonable to observe. If there are a lot of elements, they are on the face, the child combs them, there is atopic dermatitis, younger brothers and sisters or swimming and wrestling - active removal is usually justified. An additional argument in favor of removal is practical: as long as the nodules are there, the child remains a source of infection, and it may not be possible to “wait it out” because the circle closes within the family.
When and what to treat
There is no single correct method: the approach is chosen based on the child’s age, the number and location of elements, skin condition and tolerability of the procedures. The general logic is that in young children the least traumatic and least painful methods are preferred.
- Механическое удаление содержимого узелка кюреткой или пинцетом — быстрый и надёжный способ; у детей проводится после нанесения обезболивающего крема, который выдерживают на коже около часа.
- Криодеструкция жидким азотом — короткое замораживание каждого элемента; обычно требуется несколько сеансов.
- Лазерное или радиоволновое удаление — при большом количестве элементов и в труднодоступных зонах.
- Наружные препараты, вызывающие контролируемое отшелушивание или иммунный ответ, — назначаются врачом, когда механические методы нежелательны.
- Наблюдение без вмешательства — полноценный вариант при единичных элементах у здорового ребёнка, но с оговоркой о заразности.
- Параллельно — лечение сопутствующего атопического дерматита и восстановление кожного барьера эмолентами, иначе высыпания будут возвращаться.
Why squeezing houses is a bad idea
The contents of the nodule are squeezed out easily, and it is this ease that encourages parents to solve the problem themselves with nails or tweezers. The difference between medical removal and home squeezing is not in the movement itself, but in everything that surrounds it.
- The contents of the nodule are densely saturated with the virus: the squeezed out mass gets onto the surrounding skin and hands, and instead of one element, a dozen appear in two to three weeks.
- Unsterile instruments and untreated skin are a direct path to bacterial infection, even purulent inflammation.
- Deep trauma with nails leaves a scar where the mollusk itself would disappear without a trace
- Manipulations on the face and eyelids are especially dangerous: a scar in a visible place and irritation of the eye are not comparable with the benefits
- During medical removal, both the element itself and the skin around it are treated, and the instrument is sterile
- A painful procedure without anesthesia creates a persistent fear of any medical procedures in a child.
Separately, it is worth mentioning the external remedies that are recommended on the Internet: iodine, brilliant green, celandine, vinegar, garlic, garlic juice with salt. None of them act selectively on the virus; all they do is damage the surrounding skin. On children's skin this results in burns and persistent stains. If you want to do something on your own, daily care with emollients and control of itching is much more useful: this reduces scratching and, accordingly, spread.
Kindergarten, swimming pool and family life
Molluscum contagiosum is not a reason to isolate a child from society. It is not dangerous to health, does not cause complications to internal organs and does not require quarantine like infectious diseases. Restrictions apply only to situations where close skin-to-skin contact or shared wet surfaces occur.
- You can attend kindergarten and school; It is advisable that elements in open areas be covered with clothing or a bandage
- Swimming pool, water park, wrestling, gymnastics and other contact sports are limited during treatment, and the requirements of a particular institution are clarified in advance
- Towel, washcloth, bed linen and clothing - only individual; wash in the usual way
- Children should not bathe together in the same bath during treatment.
- Scratching is the main enemy: cut nails short, treat dry skin, and if itching is severe, discuss with your doctor means to relieve it.
- Adults with localization in the groin area should discuss the situation with a partner and undergo an examination together
And the last thing that is important for parental peace of mind. Molluscum contagiosum is not a sign of poor immunity in the average child - it is a common childhood infection, like chicken pox or the common cold, and its presence does not require an immune system test. Another thing is an adult with multiple, large or persistently recurrent elements: his widespread rashes may indeed be the first visible sign of a serious decrease in immunity, and in such a situation an examination is justified.