What is the assessment and treatment plan for a 16-year-old female with molluscum contagiosum?

Assessment and Plan for 16-Year-Old Female with Molluscum Contagiosum

Treatment of molluscum contagiosum lesions is recommended through physical removal methods including incision and curettage, simple excision, excision and cautery, or cryotherapy to prevent transmission and reduce associated symptoms. 1

Assessment

• Molluscum contagiosum presents as characteristic skin-colored, whitish, or pink papules with a shiny surface and central umbilication 2
• Lesions typically affect the trunk, face, and extremities in children and adolescents 2
• The condition is caused by a poxvirus and is transmitted through direct skin contact, fomites, or self-inoculation 3, 4
• Lesions may spontaneously resolve but can persist for months to years (6 months to 5 years) 1, 5
• Associated conjunctivitis may be present if lesions are located on or near the eyelids 1
• In adolescents, genital lesions may indicate sexual transmission 3, 6
• Multiple large lesions with minimal inflammation may indicate an immunocompromised state 1

Treatment Plan

Primary Treatment Options

• Physical removal methods (first-line therapy):
  • Incision and curettage (aggressive enough to cause bleeding) 1
  • Simple excision 1
  • Excision and cautery 1
  • Cryotherapy 1

Important Treatment Considerations

• Identify and treat all lesions, including nascent ones, to reduce risk of recurrence 1
• For multiple lesions, reducing viral load often allows the host immune response to eliminate residual virus 1
• Follow-up is not usually necessary unless conjunctivitis persists 1

Alternative Treatment Options

• Chemical treatments may be considered:
  • Potassium hydroxide 7
  • Salicylic acid 7
  • Hydrogen peroxide 7
  • Cantharidin 7

Special Considerations

• Imiquimod is not recommended for molluscum contagiosum in pediatric patients:

  • Clinical studies failed to demonstrate efficacy in children with molluscum contagiosum 8
  • Side effects include application site reactions, erythema, edema, and potential systemic absorption 8

• If lesions are near the eyes with associated conjunctivitis:

  • Monitor for resolution of conjunctivitis after lesion removal 1
  • Conjunctivitis may take weeks to resolve after elimination of the lesions 1

• If extensive or recalcitrant disease is present:

  • Consider screening for immunocompromised state 1
  • Referral to dermatology may be necessary for examination of other suspicious lesions 1

• If genital lesions are present:

  • Consider screening for other sexually transmitted infections 3

Patient Education

• Inform patient that the condition is contagious but benign 5, 4
• Advise avoiding sharing personal items to prevent transmission 6, 5
• Explain that lesions may recur and require additional treatment 5
• Reassure that complete resolution typically occurs, though it may take several months 5, 4

Follow-up

• Schedule follow-up only if:
  • Conjunctivitis persists after lesion removal 1
  • Lesions are extensive or recurrent, suggesting possible immunocompromise 1
  • New lesions develop despite treatment 5