Warts and Molluscum in Kids: Those Bothersome Bumps!

Jeanne Findlay, DNP, CPNP, CCRP; Bernard A. Cohen, MD

Disclosures

June 02, 2011

The Case of the Bumps That Won't Go Away

History

Mark, a 9-year-old boy, presents in your clinic with a chief complaint of being teased about the increasing number of warts on his hands, which were first noted 9 months ago. He denies picking at the lesions, although he does habitually bite his nails. His medical history is noncontributory. Mark and his parents report that they have treated him with over-the-counter band aids impregnated with salicylic acid. When that was ineffective, they tried a nonprescription formulation of cryotherapy, which was also ineffective. They noted that they read on the Internet about using duct tape to get rid of warts, and they wonder whether they should try this treatment option. Additionally, his mother is concerned that Mark's warts are spreading because some small bumps are developing on his face and chest.

Family history. Mark's 7-year- old brother has had warts on his hands and feet for nearly 2 years. That sibling additionally has a history of mild eczema. There are no other known contacts or family members who have warts.

Social history. Mark has been on a swim team for the past several years and swims 3 to 4 days per week.

Physical Examination

Figure. What is the diagnosis?

Mark is a well-nourished, well-developed youngster who appears his stated age and is in no acute distress.

  • Face: > 10 nonerythematous 1- to 2-mm firm, waxy papules on left lateral cheek. Several of the papules appear umbilicated. Lips and oral mucosa are without lesions;

  • Anterior trunk: > 20 waxy, firm, 1- to 3-mm papules on midchest and left flank. Some of the lesions are erythematous, nontender but crusted;

  • Posterior trunk: cluster of > 10 pinpoint-sized, nonerythematous, firm papules on lower back proximal to buttocks cleft;

  • Arms and legs: mild xerosis without scale, erythema, or excoriations;

  • Hands and feet: coalescing, nonerythematous, hyperkeratotic papules periungually on 7 fingers; lesions vary in size from 3 to 9 mm. Solitary, nontender 2-mm hyperkeratotic papule in arch of left foot; and

  • External genitalia and buttocks: Tanner stage 1 circumcised male; testes descended bilaterally. Anus without erythema, tears, or bruises. No skin tags, hemorrhoids, or other skin lesions.

The remainder of examination is within normal limits.

Diagnostic Evaluation

Visual examination and clinical appearance only are necessary.

Diagnosis

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