Molluscum is more common in children with eczema than in children without eczema. Dermatologists believe this might be partly because the genetics of people with eczema. They have microscopic cracks and fissures in the skin which make it easier for the molluscum virus to enter. “The skin of patients with eczema, or atopic dermatitis, often has a defective barrier, which is what protects us from the outside world” says Anthony J. Mancini, M.D., Professor of Pediatrics and Dermatology at Northwestern University Feinberg School of Medicine and Head of the Division of Dermatology at Ann & Robert H. Lurie Children’s Hospital of Chicago. “As a result, these patients are more prone to a variety of skin infections, including viral skin infections, like molluscum.”
It may feel overwhelming to families when a child battles these two skin problems simultaneously. But Dr. Mancini says, “Keep in mind that both of these conditions are quite treatable. It’s important to consider each disorder independently, even when they occur in the same patient.”
According to Dr. Mancini, here are five important considerations that may apply to your child’s condition and lead to a discussion with your child’s doctor:
1. Molluscum can be different in children with eczema. Children with eczema may have more molluscum bumps and have bumps in more areas. “Eczema is itchy. This can cause children to scratch and spread the molluscum infection to other areas of skin (which is called “autoinoculation”) with their hands. In addition, the virus may spread more readily because of the barrier defects,” explains Dr. Mancini.
2. Molluscum can aggravate eczema. In children who already have eczema, the molluscum infection may trigger an eczema flare, especially in areas like inside of the elbow, backs of the knees, neck creases and inner thighs.
3. Molluscum can trigger an eczema-like rash even in children who have never had eczema. In some children, molluscum may cause a surrounding eczema-like rash to appear, which has been called molluscum dermatitis. “Molluscum dermatitis can occur in children with or without a history of eczema. It might represent an inflammatory response to the viral infection,” explains Dr. Mancini. (An inflammatory response is when the cells of the immune system travel to the place of the infection, sometimes causing itch, skin redness or swelling). Having molluscum dermatitis does not necessarily mean the child will have long-term problems with eczema.
4. Treating eczema first may be a good idea in children with both molluscum and eczema. Because the constant rubbing and scratching from the eczema may spread molluscum, it can be “important to clear up the dermatitis first before considering specific treatment for molluscum,” says Dr. Mancini. Once that’s accomplished, “if we choose to proceed with a specific molluscum therapy, it will be better tolerated at that point,” he adds. He also mentions that he has seen spontaneous clearing of molluscum in some of the patients he has treated successfully for eczema.
5. Dermatologists tend to advise staying the course with eczema treatments even when children with eczema develop molluscum. Therapy for eczema typically includes a skin care regimen to keep the skin moist and topical anti-inflammatory medications, whether or not a child has concomitant molluscum. “Some parents and physicians may worry about topical steroid use, especially in those areas where eczema and molluscum occur together, given concern that it could lead to spread of the molluscum. This has not been my experience,” says Dr. Mancini. “In fact, by minimizing the itch-scratch cycle, you can usually minimize the spread of molluscum to new areas.”
Because patients with both eczema and molluscum can have more complex needs, it’s key to consult with a dermatologist who can best address each condition on its own and guide you and your child to successful management of both disorders.