Pediatric emergency medicine trisk 1803 1803

The lesion, caused by the molluscipoxvirus , a member of the pox virus subfamily, is a papule with a white, umbilicated center ( Fig 88.2 ) It occurs at any age during childhood, but is more common among swimmers and wrestlers Patients with atopic eczema are especially susceptible Most lesions resolve in to months, but some may persist for years Spread is by autoinoculation FIGURE 88.1 Approach to diagnosis of papular lesions Lesions can be single or numerous and favor intertriginous areas such as the groin They are usually to mm in diameter, but several can coalesce and form larger lesions They may become inflamed, which may herald a spontaneous disappearance Often when inflamed, they look “infected” but culture is usually negative At times, an eczematous reaction occurs around the lesions Since spontaneous resolution is common, treatment, if elected, should be gentle Application of 0.1% tretinoin cream one to two times daily may induce enough inflammation to hasten the host’s immune response or cause extrusion of the central core, but caution should be observed since tretinoin may exacerbate secondary eczematization around molluscum lesions Options for surgical excision are available but are not appropriate emergency department procedures