Article : Inflammatory Reactions of Molluscum Contagiosum,,,

Inflammatory Reactions of Molluscum Contagiosum in Children

Inflammatory reactions are common in this self-limited viral skin infection.

Molluscum contagiosum (MC) is a common, self-limited viral skin infection occurring in about 20% of healthy children. Resolution occurs within a few months to a few years. Inflammatory reactions are poorly studied, but they are common, often causing pruritus, pain, and sometimes confusion with bacterial superinfection.

Investigators at a tertiary care pediatric dermatology practice performed a retrospective chart review to study inflammatory reactions in MC. In all, 696 MC patients were identified, mean age 5.5 years. Molluscum dermatitis occurred in 270 patients (39%), and inflamed MC lesions in 155 (22%). A history of atopic dermatitis was present in 259 children (37%); these patients had a significantly higher incidence of molluscum dermatitis and a significantly higher number of MC lesions (P<0.001 for both). Patients with inflamed or dermatitic MC lesions were significantly less likely than patients without such lesions to have increasing numbers of MC lesions over the next 3 months (P< 0.03). Gianotti-Crosti syndrome–like reactions (GCLRs) — papular exanthems on the elbows and knees — were noted in 34 patients (5%). GCLRs, which were commonly pruritic and associated with inflamed MC lesions, were a good prognostic sign, indicating a resolution of MC would occur within weeks.

Inflamed MC lesions were cultured in 10 patients; 9 were sterile, and only 1 grew Staphylococcus aureus. Topical cantharidin was the most commonly used treatment, applied to 475 patients. The report represents the largest published experience with this agent. Topical imiquimod, oral cimetidine, curettage, and topical retinoids were also used, in decreasing order of frequency.

Citation(s):

Berger EM et al. Experience with molluscum contagiosum and associated inflammatory reactions in a pediatric dermatology practice: The bump that rashes. Arch Dermatol 2012 Aug 20; [e-pub ahead of print].

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