Pediatric emergency medicine trisk 1803 1803

The lesion, caused by the molluscipoxvirus , a member of the pox virus
subfamily, is a papule with a white, umbilicated center ( Fig. 88.2 ). It occurs at
any age during childhood, but is more common among swimmers and wrestlers.
Patients with atopic eczema are especially susceptible. Most lesions resolve in 6
to 9 months, but some may persist for years. Spread is by autoinoculation.

FIGURE 88.1 Approach to diagnosis of papular lesions.

Lesions can be single or numerous and favor intertriginous areas such as the
groin. They are usually 2 to 5 mm in diameter, but several can coalesce and form
larger lesions. They may become inflamed, which may herald a spontaneous
disappearance. Often when inflamed, they look “infected” but culture is usually
negative. At times, an eczematous reaction occurs around the lesions.
Since spontaneous resolution is common, treatment, if elected, should be
gentle. Application of 0.1% tretinoin cream one to two times daily may induce
enough inflammation to hasten the host’s immune response or cause extrusion of
the central core, but caution should be observed since tretinoin may exacerbate
secondary eczematization around molluscum lesions. Options for surgical
excision are available but are not appropriate emergency department procedures.