What patient teaching is recommended for a patient with molluscum contagiosum?

Patient Teaching for Molluscum Contagiosum

The most important patient teaching for molluscum contagiosum includes covering visible lesions with clothing or bandages, maintaining good hand hygiene, avoiding sharing personal items, and preventing scratching or picking at lesions to prevent autoinoculation and transmission to others. 1

Transmission Prevention Measures

• Cover lesions: Instruct patients to cover visible lesions with clothing or waterproof bandages, especially when participating in activities involving skin-to-skin contact
• Hand hygiene: Emphasize frequent handwashing, particularly after touching lesions
• Avoid sharing personal items: Advise against sharing towels, clothing, bath sponges, or other personal items that may come in contact with lesions
• Prevent autoinoculation: Teach patients not to scratch, pick, or shave areas with lesions to prevent spreading to other body areas
• Intimate contact: Recommend avoiding intimate or close physical contact until lesions resolve, particularly for adults with genital lesions 1, 2

Special Considerations for Different Populations

For Children

• Explain to parents that the condition affects 5-11% of children aged 0-16 years 1
• Reassure that the condition is typically self-limiting, resolving within 6-9 months in most cases 3
• Advise parents to monitor for signs of secondary bacterial infection or eczematous reactions around lesions
• Inform school/daycare about the condition, but note that exclusion is generally not necessary if lesions can be covered

For Adults with Genital Lesions

• Emphasize the importance of abstaining from intimate contact until lesions resolve
• Recommend informing sexual partners about the condition
• Consider screening for other sexually transmitted infections when appropriate

For Immunocompromised Patients

• Explain that lesions may be more numerous, larger, and more persistent
• Emphasize the importance of prompt treatment to prevent extensive spread
• More frequent follow-up may be necessary 1

Treatment Expectations

• Natural course: Inform patients that molluscum contagiosum is self-limiting, with spontaneous resolution typically occurring within 6-9 months 3
• Treatment options: If treatment is pursued, explain the procedure, expected outcomes, and potential side effects:
  • Cryotherapy: May cause pain, blistering, and potential hyperpigmentation
  • Curettage: Immediate removal but may cause discomfort
  • Cantharidin: Well-tolerated with minimal side effects
  • Potassium hydroxide: Comparable efficacy to cryotherapy 1
• Imiquimod ineffectiveness: Note that imiquimod has not been shown to be more effective than placebo for molluscum contagiosum, despite sometimes being prescribed 1, 4

Follow-up Guidance

• Recommend regular monitoring every 1-3 months to assess progression 1
• Advise patients to return sooner if:
  • Lesions become red, painful, or warm (signs of secondary infection)
  • Rash develops around lesions (molluscum dermatitis)
  • New lesions appear in previously unaffected areas
  • Lesions persist beyond 6-12 months

Common Pitfalls to Avoid

• Overtreatment: Explain that asymptomatic, limited lesions in immunocompetent patients may be observed for spontaneous resolution for 3-6 months before considering active treatment 1
• Inadequate infection control: Emphasize that proper hygiene and covering lesions are essential to prevent spread
• Ignoring complications: Teach patients to recognize signs of secondary bacterial infection or eczematous dermatitis
• Unnecessary restrictions: Clarify that children with covered lesions can generally participate in school and sports activities

By following these teaching points, patients can effectively manage molluscum contagiosum while minimizing transmission and complications.