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Molluscum contagiosum and warts represent two of the most common cutaneous infections seen in children. While both are considered benign, self-limited viral infections, they can create a significant amount of anxiety in both patients and parents as a result of their persistence and because of the social stigma that remain attached to their presence.
In most children, both molluscum contagiosum and warts are asymptomatic, and the majority of lesions usually resolve within 2 years without active treatment. However, many therapeutic options - mechanical, chemical, surgical, and immunologic - are available for those children who have persistent, recurrent, symptomatic, or extensive disease. Older therapies that remain efficacious today include cantharidin, podophyllin, salicylic acid, simple occlusion, and cryotherapy. Newer treatment options include the topical agents tretinoin, imiquimod, and 5-fluorouracil, as well as the use of the pulseddye laser. Other therapeutic modalities generally restricted to specialists and reserved for particularly recalcitrant cases include the use of contact sensitizers, such as squaric acid dibutylester, injection of Candida antigens, and topical or intravenous cidofovir.
Active nonintervention remains a viable option for many children with limited infection with moiluscum or warts, as eventual spontaneous resolution is the general rule. Many of the older therapies for warts and moiluscum carried a significant risk of pain and emotional distress to the child, and therefore the treatment was often less tolerable than the infection.
Newer therapies, although not entirely painless, produce less irritation and seem to be better tolerated by children of all ages, making treatment more acceptable to patient, parent, and physician. It is therefore reasonable to discuss available therapeutic options with all families who seek advice on the treatment of warts and moiluscum contagiosum infections in their children as part of the decision-making process. Therapy should be tailored to each patient after consideration of several factors, including the child's age, extent and location of lesions, cost, and compliance. Parents and practitioners should recognize that no treatment modality is fail-safe, that recurrences are common, and that active nonintervention is often a reasonable alternative.
MOLLUSCUM CONTAGIOSUM
Etiology and Epidemiology
Molluscum contagiosum results from infection with the moiluscum contagiosum virus (MCV), a large DNA poxvirus. On the basis of genome analysis, four subtypes have been identified, MCVl through MCV4. Most infections are caused by MCVl,...