Molluscum

Letting the immune system clear the bumps on its own while the skin is monitored. Many guidelines describe this as a reasonable choice for otherwise healthy people.

The bumps are few, not bothersome, and the person is otherwise healthy. Many families choose this because the bumps tend to go away without scars.

There are many bumps, genital bumps, eczema that is flaring, a weakened immune system, or a strong wish to lower the chance of spreading it to others.

New bumps, bumps near the eyes, redness or pain suggesting infection, and eczema that gets worse. Clearing can take many months to a few years.

Often 6 to 18 months, sometimes longer. A clinician may check in periodically.

• Is waiting a reasonable choice in my or my child's situation?
• How will we know if it is time to talk about treatment?
• What should we do about school, sports and swimming while we wait?

Everyday steps to lower the chance of spreading the virus: avoid picking or scratching, wash hands, cover bumps with clothing or a waterproof bandage, and keep towels, clothing and sports gear to yourself.

At any stage, whether or not other treatment is used. Clinicians commonly recommend these steps to everyone with molluscum.

These steps are generally safe for all ages. Young children may need help with covering bumps and not scratching.

Itchy skin that is hard to leave alone, and any scratched or broken skin that looks infected.

Until every bump is gone.

• Can my child go to school, swim or play sports, and how should bumps be covered?
• How can we manage itching so scratching is less likely?
• How should we handle towels, bath time and siblings at home?

Store-bought wart removers, acids and home remedies are sometimes tried on molluscum. The FDA has warned that non-prescription products sold for molluscum are unlikely to do what they claim.

Most clinicians do not suggest these. They are most often brought up because people have already tried them or are tempted to.

Not suitable for the face, genitals, skin with eczema, or young children, and not for anyone with a weakened immune system unless a clinician agrees.

Burns, blisters, scarring, dark or light marks, allergic reactions, and spreading the virus by picking or scrubbing.

No reliable timeline, because effectiveness is unproven.

• Is there any over-the-counter product you would consider safe to use?
• I already tried something and my skin is irritated. What should I do?
• Are there home remedies I should avoid?

A prescription gel that the FDA approved in January 2024 for molluscum in adults and children 1 year and older. Unlike in-office treatments, it can be applied at home by the patient, parent or caregiver as directed by a clinician.

Families prefer a treatment done at home rather than in the office, or a child may not tolerate in-office procedures.

Not suitable for the eyes. Someone with a past reaction to its ingredients should not use it. Cost and insurance coverage vary. Ask a clinician about use around the genitals and other sensitive areas.

Skin irritation, redness, itching or swelling where it is applied. Report anything that seems more than mild.

Treatment is judged over a number of weeks. A clinician will explain what to expect and when to review progress.

• Would a home-applied gel make sense for my child or me?
• What skin reactions are expected, and which ones mean I should call you?
• Will my insurance cover it, and what are the alternatives?

Several other creams and solutions are sometimes used, often off-label (not specifically approved for molluscum). Examples include retinoids such as tretinoin, the immune-modulating cream imiquimod, and potassium hydroxide solutions. Evidence for these is more mixed.

A clinician wants a gentler approach at home, the approved options are not suitable or available, or other treatments have not worked.

Sensitive or eczema-prone skin can become irritated. Some are not suitable for pregnancy or for use near the eyes or on the genitals. Always ask about the specific product.

Redness, peeling, burning, itching, and new eczema flares. Stop and call the clinician if skin looks very irritated.

Often weeks to months, and results vary. A clinician will advise how to judge progress.

• Is an off-label topical reasonable here, and what does the evidence show?
• What irritation is expected and what is too much?
• Is it safe in pregnancy, or for my child's age?

Clinicians may treat the skin around the bumps rather than the virus itself, for example with moisturizers or prescription anti-inflammatory creams for itchy, eczema-like skin, or with antibiotics if a bump becomes infected.

Bumps are itchy or inflamed, eczema is flaring around them, or there are signs of a bacterial infection.

Anti-inflammatory creams are chosen carefully because skin barrier problems can make spread easier. Antibiotics are only for true bacterial infection, not for molluscum itself.

Thinning or color change from strong creams used too long, and continued spread. Report infection signs promptly.

Itch and eczema often improve within days to a few weeks once the right plan is in place.

• Should my eczema be treated more actively while the bumps are there?
• How do I tell normal inflammation from infection?
• Which moisturizers and cleansers are best for this skin?

A medicine made from a blister beetle substance, applied to the bumps by a health care provider in the office. It causes a small blister that lifts the bump off. The FDA approved the product Ycanth in July 2023 for people 2 years and older.

Treatment is wanted, there are several bumps, and a child or adult can sit through a quick in-office application. It is not applied at home.

Not for use near the eyes or on the genitals or mucous membranes unless a clinician decides otherwise. Younger than 2 years, or a past reaction to it. Do not use cantharidin products from unknown sources.

Blisters, redness, burning, stinging, itching or crusting where it was applied, and sometimes temporary dark or light marks, especially on brown and Black skin. Sometimes blisters can be uncomfortable.

Bumps often respond within weeks, and more than one visit may be needed. A clinician will advise on follow-up.

• Is cantharidin a good fit for my child or me, and what will the blisters look like?
• What aftercare is needed, and what should I do if a blister is painful?
• Is there a risk of dark or light marks on my skin tone?

A clinician uses a small, spoon-shaped instrument to scrape out the bumps, usually after numbing the skin with a cream or injection.

There are only a few bumps, treatment is wanted, and the patient is older or able to stay still. It is often used in teens and adults.

Very young or anxious children, people with many bumps, bumps near the eyes, and people who scar easily or have a tendency to keloids.

Pain, bleeding, scabbing, infection signs, and sometimes small scars or color changes.

Bumps are removed during the visit. New ones can still appear later, so follow-up may be needed.

• How will you numb the area, and how uncomfortable is it?
• What is the chance of scarring or color change on my skin?
• What if new bumps appear afterward?

A clinician applies very cold liquid nitrogen briefly to each bump to freeze it off.

Treatment is wanted and the patient is old enough to tolerate a stinging, cold sensation. Often used for teens and adults.

Young children, who often find it painful, and people with many bumps. Use with care on darker skin because freezing can lighten or darken the skin.

Pain, blisters, scabs, and temporary or lasting light or dark marks, plus occasional scarring.

Often needs several visits, spaced a few weeks apart. A clinician will tell you how to judge progress.

• How painful is freezing, and is it a good fit for a child?
• What is the risk of color change on my skin tone?
• How many visits might I need?