When you find out your child’s bumps are molluscum, you wonder, should we get these bumps treated?
“Not every child in the universe has to be treated for molluscum. But a very large proportion of children with molluscum may require intervention, and we want parents to know that treatments are available,” says Nanette Silverberg, M.D., clinical professor of dermatology and pediatric dermatology at the Icahn School of Medicine at Mount Sinai in New York City. There is no FDA-approved drug, but many dermatologists treat molluscum with in-office procedures.
The goal of treatment is to remove the bumps (also called “lesions”) or help them go away more quickly than they would on their own. The infection often clears up in about a year, but it can last for up to four years and cause symptoms and distress in many kids. Treatment is ultimately “a joint decision between doctor and family,” says Dr. Silverberg, who has reported on reasons to treat in a 2019 Cutis article.
“Symptoms and spread are two important reasons to treat,” she says.
It is not uncommon for children with molluscum to deal with red and swollen bumps and an itchy rash around the bumps. “We want to keep kids comfortable, so treatment is recommended in these cases.”
Treating symptoms can also help to prevent children from scratching and spreading the infection elsewhere on their bodies. But molluscum can spread in many kids, even without significant scratching. “Treatment is often a balancing act between addressing the symptoms and the spread,” says Dr. Silverberg.
The variability of this virus—its unpredictability–is one of the many reasons why it’s important to consult a dermatologist when a child develops molluscum.
“Some children have only a few lesions, and no new spots even a year later. Other children start out with super itchy, terrible-looking lesions that continue to spread. Still, other kids start out with a mild case but six months later develop a severe rash,” describes Dr. Silverberg. Even more vexing is the virus’s variability within a family: “one sibling may have 2 lesions, but the sibling he infects gets 22 lesions. We, pediatric dermatologists, tend to see the worst cases, with lots of family members affected, and a lot of anxiety in caregivers and children,” she says.
According to a 2015 study in Lancet Infectious Diseases, transmission to siblings occurs in about 40% of molluscum cases. With the spread to siblings so common, it’s easy to see why stress could be high in households. Parents may feel they’re playing “whack-a-mole” with the virus and with an infection that can spread despite conscientious efforts to stop the spread. Families may know to avoid bath-sharing with siblings. Still, it’s challenging to monitor touching and sharing of toys and bath towels.
The Brooklyn-based Shea family knows about how molluscum can wreak havoc on a household. “It was summer, and sisters play with each other,” says Gabrielle, a marketing manager and mother of three daughters. Eight-year-old Maya developed a few molluscum bumps on her back; 9-year-old Marley managed to dodge the infection, but then 4-year-old McKenna developed a doozy of a case, just as her big sister’s infection was going away. “The bumps on McKenna were intensely itchy and sprouted all over her body– legs, arms, back, torso,” says Gabrielle. Although they recognized the bumps the second time around, the severity of McKenna’s case sparked a ‘what is going on?’ panic, she says. “We felt so bad for her because she was suffering with all the itchiness. But still, she was a trooper about her ‘bumpies,’ as she called them.”
Their pediatrician recommended they wait for the infection to go away on its own, just as they had with Maya. “It wound up being a months-long roller coaster ride. Each set of bumps would go through a cycle where the bumps would burst and bleed and then go away. So we’d have the relief of checking a group of bumps off the list—okay, her arms are better now. Now we’ll wait for her legs to go through that cycle.”
Many families consult a dermatologist because they’re unwilling to wait it out and hope to keep the infection from dragging out, infecting siblings, or lingering for years.
“Some pregnant moms are afraid their newborns will catch it from the younger siblings. Anticipating this scenario is another valid reason for treating young siblings before they transmit it to others. Factoring family dynamics is part of evaluating each child’s case,” says Dr. Silverberg.
Dermatologists also recommend treatment in another stressful scenario—when molluscum stigmatizes a child. “Some children with molluscum find that their friends are avoiding playing with them. Their friends may think molluscum is something dangerous or they want to avoid catching it, so playdates get dropped,” says Dr. Silverberg. Kids who have prominent crusty lesions on their face or tops of their hands may feel especially self-conscious or ostracized.
Dr. Silverberg states, “We do see some children with molluscum experience severe impairments on their quality of life.”
While daycare and school can’t bar molluscum-infected kids, “in May and June we see camps telling families that their kids with molluscum can’t swim because they’re contagious,” says Dr. Silverberg. Older children also run into problems with sports. The virus can be transmitted through sports equipment, and kids face limitations in playing contact sports like wrestling.
“Socializing more freely, integrating with other children, and minimizing self-consciousness, which especially affects older kids, are all potential reasons to treat,” she adds.
And finally, children with eczema can face additional challenges if they develop molluscum, too. “Molluscum can trigger eczema to develop; it also triggers eczema flare-ups in kids who already have eczema. Treating the molluscum controls and improves both conditions,” she says.
Because there are so many shifting factors and a range of reasons to treat molluscum, it’s important to consult a dermatologist to assess the full picture. “We see the family dynamics when we see children. It’s my responsibility to evaluate what’s best for a child’s skin, but I also consider what’s most likely to remove the molluscum through a faster mechanism if a child is emotionally bothered by it,” says Dr. Silverberg. When parents are anxious about the virus, education from a dermatologist can help, too. “The Internet is a double-edged sword. For instance, when parents read that molluscum is related to the smallpox virus, they can get freaked out about it. But a dermatologist can explain how it’s a non-threatening infection that may not require treatment, at least for now. Treatment is always tailored to a child. If we don’t treat the first day, maybe we treat it in a few weeks. A dermatologist can help in this process,” she says.