Thursday, January 17, 2013

Little White Bumps - A Common Rash


     A common rash in young children and adolescents is called molluscum contagiousum.  The name is unfortunate – they are minimally contagious. A sibling might catch them from another sibling, but they don’t spread through the daycare.
     They are little raised bumps that are white and have a mucous-like substance in them. If you lift off the thin membrane covering the bump, a white wad of mucous comes out. They can occur in a group or on different areas on the body. They do not have any redness or irritation around them and they do not hurt or itch (although if they are picked at or rubbed, they can get inflamed or infected). If you look closely, you will see a small “belly-button-like” dimple directly in the center of the bump. They are usually all about the same size but sometimes can vary in size.
     If your child has red, raised, itchy lesions, which are various sizes and seem to come and go, he probably has hives. Molluscum contagiosum comes on and stays – often for weeks.
     No treatment is necessary for molluscum contagiosum. If left alone, they finally go away just as mysteriously as they came. If they get infected, covering them with an antibacterial ointment and a band-aid usually heals them. However, any red, swollen, painful skin lesion needs to be seen by the child’s caregiver.
     There has always been a discrepancy between the way dermatologists and pediatricians deal with molluscum contagiosum. Dermatologists treat molluscum aggressively by picking each lesion off, burning them off or putting wart-removing chemicals on them. I found early in my career that after I picked off 25 or so molluscum, the child was bloody and crying, the mother and even the nurse were crying and, within 2 weeks, a hole new crop of molluscum would pop up. Dermatologists insist that by treating molluscum they go away faster, but I’ve never found that to be the case. I’ve also never found the minimal improvement that treatment affords to be worth the discomfort (and sometimes scarring) caused by the treatment.

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