8-Year-Old With Facial Lesions

Differential Diagnosis

• Folliculitis
• Lobular capillary hemangioma
• Milia
• Molluscum contagiosum (pediatric)

Diagnosis

The correct diagnosis for the patient in this case is pediatric molluscum contagiosum.

Molluscum contagiosum is a common viral skin infection of childhood caused by a DNA poxvirus. It is usually transmitted by direct skin-to-skin contact, through fomites, or from autoinoculation. There is an increased incidence in children with underlying atopic dermatitis, swimmers, children who bathe together, those who share towels, and immunosuppressed people. The exact incubation period is unknown but is estimated to be between 2 and 6 weeks. Though self-limited, the infection is often chronic and can range from a few months to 4 years before disappearing.

What to Look For

• Typical lesions are 2-5mm firm, dome shaped, skin-colored papules with a shiny surface and central umbilication
• Lesions can appear anywhere on the body except palms and soles, most commonly on the trunk, axilla, antecubital and popliteal fossa
• Lesions may be itchy and may become inflamed

Pearls For Urgent Care Management

• For immunocompetent patients, molluscum contagiosum is self-resolving with individual lesions resolving in months, however, overall infection may take up to 5 years to resolve
• Treatment with cryotherapy, curettage, cantharidin, and podophyllotoxin may be considered in severe cases
• Molluscum dermatitis is common (eczematous patches surrounding the lesions) and may be treated with topical corticosteroids (low or medium potency)

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