How to treat molluscum skin rash
The middle-schooler and his mom were waiting patiently behind the closed exam room door. I stood out in the hall reading the nurse's note that described the reason for their visit.
With the help of this brief paragraph, I felt sure I had the answer to the boy's problem before even entering the room.
I went in to check on my patient, and asked the boy and his mom for more details about the several-months-old rash on the left side of his neck. The pair reported that the area consisted of about 15 small bumps, which were not red, not oozing, not pustular and not itchy.
A few additional lesions had appeared since the rash started, but otherwise, the quality of the individual lesions had not changed much.
Most pediatric skin rashes would have either spontaneously resolved or dramatically worsened long before - which is why I had narrowed my diagnosis down to one likely possibility before the visit was even under way.
When I examined the boy's neck, I found just what I'd been expecting: a cluster of small pearly lesions, some with central umbilications - that is, depressed or belly buttonlike centers. Though the name is fearsome sounding - molluscum contagiousum - this skin rash is seen relatively frequently in kids, and is considered a benign condition.
Like its dermatologic cousin, the common skin wart, molluscum is caused by a virus. The molluscum bug is the poxvirus, which can be spread to other people, but is not as highly contagious as respiratory viruses such as influenza.
An affected patient can, however, easily auto-inoculate himself. In other words, a child can scratch his few molluscum lesions and scratch another area of the body, transporting the offending pox particles to a new site, creating still more mollusca.
According to specialists at the American Academy of Dermatology, molluscum is more common in children than adults due to lack of poxvirus immunity and the increased likelihood of skin contact among younger members of the population.
Kids who live in the warm, humid climates favored by the virus are known to be at increased risk of acquiring molluscum, as are children with eczema (due to their vulnerable, irritated skin surfaces) and those with suppressed immune systems.
If treatment is indicated, the AAD notes that dermatologists have several tools in their arsenal, including freezing, electrocautery, scraping, laser therapy and the use of acid or blistering solutions.
Another option is home therapy with one of several prescription topical medications. Treatment can extend over several weeks.
If the bumps are few in number, not red and inflamed, not causing discomfort, not spreading to other body surfaces, and not a major cosmetic issue for the child, parents can safely exercise the option of "benign neglect" - watchful waiting without therapy.
As with warts, many molluscum lesions can eventually disappear on their own, though this can take months or years.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.