Ann L. Chou; Kimberly G. Yen, MD

Disclosures

May 10, 2013

Discussion

Molluscum contagiosum is a highly contagious poxvirus infection of the skin. It presents as small, pearly or flesh-colored papules with flattened, umbilicated tops. Molluscum contagiosum is commonly found in immunocompetent children, but it may also be found in healthy adults as a sexually transmitted disease, in participants of contact sports, and in immunodeficient individuals.[1] It is transmitted from person to person through direct skin contact or through fomites carrying virus particles. Autoinoculation among children, as seen in this patient, is common and occurs when the child scratches the infected site and transmits the virus to other areas of the body.[1]

Molluscum contagiosum usually resolves spontaneously within several weeks, although full resolution can sometimes take up to several years.[2] Immediate treatment is advised for papules that are persistent, in locations that might cause complications, or for those that occur with accompanying symptoms, such as pruritus.[1,3] Periocular papules are typically on the eyelids or eyelid margins and can cause complications such as chronic follicular conjunctivitis, keratitis, or pannus.[4]

Although the traditional treatment course is "benign neglect," options for quickly resolving molluscum contagiosum include topical medications, cryotherapy, and curettage. Typical topical medications are blistering agents such as cantharidin or immunomodulators such as imiquimod.[1,2] Of these drugs, cantharidin is favored for its painless application, lack of scarring, and high lesion clearance. Cryotherapy is a cost-effective and rapid treatment, but it can be painful and lead to scarring.[2] Although medications and cryotherapy are effective in removing the virus, they are unsuitable for periocular lesions. Topical medications could cause corneal scarring, and cryotherapy poses the risk of affecting the appearance and function of the eyelid.

Curettage is the treatment of choice for periocular lesions because it allows for immediate resolution with only low risk for damage to the globe and its surrounding structures.[2,4] During curettage, the pediatric patient is placed under general anesthesia, a superficial portion of the lesion is opened, and the core of the lesion containing the viral particles is completely scraped out to prevent recurrent infection. Topical antibiotics are applied for several days until fully healed.[1,3,4]

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