Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Molluscum Contagiosum
A benign viral, self-limited disease of the skin with no systemic manifestations. It is characterized by waxy, umbilicated papules.
I. Etiology: Poxvirus
II. Incidence
A. Most common in children and adolescents
B. May affect any age
C. Commonly seen in patients with AIDS as an opportunistic infection.
III. Incubation period
A. Generally between 2 and 7 weeks
B. May be as long as 6 months
IV. Communicability
A. Period of communicability is unknown.
B. Infectivity is low, although occasional outbreaks have occurred.
C. Contracted by direct contact, fomites, and autoinoculation
D. Transmission may occur through bathing or swimming in pools.
E. Humans are the only known source of the virus.
F. Considered an STD in adolescents.
V. Subjective data
A. Complaints of “warts” or bumps
B. May be one or two to hundreds of lesions
C. Occasional complaints of infected lesions
D. Often asymptomatic and found on physical exam
VI. Objective data
A. Papules: 1 to 5 mm in diameter
1. Pearly white or skin-colored
2. Waxy
3. Umbilicated
4. Isolated or in clusters
B. Distribution
1. Face
2. Trunk
3. Lower abdomen
4. Pubis, penis
5. Thighs
6. Mucosa
7. Involvement of palms and soles is rare.
C. Check for secondary infection.
D. Screen for concomitant STDs in adolescents.
E. No associated systemic manifestations
VII. Assessment
A. Diagnosis is usually made by the characteristic appearance of the lesions.
B. Diagnosis can be confirmed by scraping lesions and viewing molluscum bodies under magnification.
C. Differential diagnoses
1. Warts are the most common differential diagnosis.
2. Closed comedones
3. Condyloma acuminata
VIII. Plan
A. Some physicians recommend no treatment, but the lifespan of the lesions can be months to years, and it is distressing to parents and children. Therefore, a treatment trial should be attempted using the least traumatic method for the numbers of lesions present. Sometimes children cure themselves by picking at the lesions, causing them to disappear.
B. Treatment options
1. Curettage
a. Remove each lesion with a sharp curette.
b. May cause scarring.
2. Trichloracetic acid 25%
a. Apply to base of each lesion, avoiding surrounding skin.
3. Occlusal-HP
a. Apply to lesion with toothpick.
b. Cover with tape.
c. Remove tape after 12 hours.
4. Retin-A gel 0.01%
a. Apply to lesions once daily.
b. Treatment course is 2–3 months duration.
c. May cause local irritation.
5. Aldara 5% cream
a. For recalcitrant lesions
b. Apply once daily for 5 days/week
c. Leave on overnight.
d. Treatment course is 4–12 weeks duration.
6. When conventional treatment has failed, particularly in a child with atopic dermatitis, add
a. Tagamet, 40 mg/kg/d in divided doses bid–tid
b. Limited studies have demonstrated moderate success.
7. Infected lesions
a. Hot soaks 5 to 6 times a day for 10 minutes
b. Neosporin ointment
8. Genital lesions: Rule out sexual abuse.
9. Cryosurgery if only a few lesions and at least 1 cm apart
a. Apply by spray or applicator.
b. Repeat treatment at 2–3 week intervals.
c. May cause scarring and/or hyper or hypopigmentation.
IX. Education
A. Lesions are generally self-limited and may last for 6 to 9 months but can last for years.
B. Recurrences are common.
C. Trauma to or infection of a lesion may cause it to disappear.
D. Treatment prevents spread by autoinoculation.
E. Restrict direct body contact with infected child to prevent spread.
F. Can be spread by contact with contaminated surfaces
G. Children with atopic dermatitis are prone to development of widespread lesions.
H. Although many lesions can be and are picked off by children, they may become secondarily infected.
I. Topical medications may cause erythema, blistering, peeling, itching, changes in skin color, or mild to moderate pain.
J. Do not share towels or clothing.
K. Infected siblings should not share bath.
X. Follow-up
A. Recheck in office in 1 week.
B. Repeat visits as necessary to treat lesions.
C. Call if inflammatory reaction to local medication.
XI. Complications
A. Secondary infection
B. Reaction to local treatment
XII. Consultation/referral
A. Question of sexual abuse
B. Multiple, widespread lesions nonresponsive to treatment; refer to dermatologist.