From the Guidelines
For an infected molluscum contagiosum in a 3-year-old child, I recommend treating the secondary bacterial infection first with topical antibiotics such as mupirocin (Bactroban) 2% ointment applied three times daily for 7-10 days, as suggested by the most recent guidelines 1.
Key Considerations
- If the infection appears more severe with significant redness, swelling, or drainage, oral antibiotics like cephalexin (25-50 mg/kg/day divided into 4 doses) for 7-10 days may be necessary.
- Once the bacterial infection resolves, the molluscum itself can be addressed, with watchful waiting often being appropriate for young children as molluscum typically resolves spontaneously within 6-18 months 1.
- Aggressive treatments should be avoided in this age group due to pain and potential scarring.
- Keeping the area clean with gentle soap and water, avoiding sharing towels or bathwater, and preventing the child from scratching or picking at lesions can help prevent spread and secondary infection.
- If lesions are extensive, causing discomfort, or psychologically distressing, consulting a dermatologist for potential gentle removal options is recommended, considering the latest preferred practice patterns 1.
Treatment Options
- Topical antibiotics for secondary bacterial infection
- Watchful waiting for molluscum contagiosum
- Gentle removal options for extensive or distressing lesions
- Keeping the area clean and preventing further infection
- Consulting a dermatologist for specialized care when necessary, based on the most recent and highest quality evidence 1.
From the Research
Infected Molluscum Contagiosum in a 3-Year-Old
Overview of Molluscum Contagiosum
- Molluscum contagiosum is a viral infection caused by the molluscum contagiosum virus (MCV) that affects the skin, leading to small, firm, dome-shaped, umbilicated papules 2, 3.
- It is a common condition in childhood, often resolving spontaneously within 6 months to several years, but can be complicated by comorbid dermatitis, especially in children with atopic dermatitis 2.
Transmission and Considerations
- The virus is transmitted through close contact with infected individuals, often in settings like pools, day care, and bathtubs 2.
- While watchful waiting can be an appropriate management strategy, treatment may be considered to alleviate discomfort, prevent spread, and address social stigma associated with visible lesions 3.
Treatment Options
- Various treatment options are available, including destructive therapies (curettage, cryotherapy, cantharidin), immunomodulators, and antivirals 3.
- Cantharidin is a commonly used treatment for molluscum contagiosum, applied topically to induce blistering and eventual resolution of the lesions 3, 4, 5, 6.
Efficacy and Safety of Cantharidin
- Studies have demonstrated the efficacy and safety of cantharidin in treating pediatric molluscum contagiosum, with high rates of lesion clearance and minimal side effects 4, 5.
- Common side effects of cantharidin include local erythema, burning sensation, and blisters, but these are generally well-tolerated and transient 4, 5, 6.
Management Approach
- The decision to treat molluscum contagiosum should be made jointly among the child, parents/guardians, and the practitioner, prioritizing reduction of symptoms, spread, and disease remission 2.
- Cantharidin can be considered a safe and effective treatment option for molluscum contagiosum in children, with application every 3 to 4 weeks as needed 6.