Episode 15: What's that skin bump? Molluscum contagiosum and warts!

In this episode of Ask Dr Jessica, Dr Jessica Hochman continues her conversation with Dr. Nicole Harter and they talk about common contagious skin conditions in childhood: molluscom contagiosum and warts.  Dr Harter will tell you everything you've ever wanted to know about mollusucum--she explains what it looks like, how long to expect it to last, when to treat it and how to prevent spread.  She also describes the common wart (@14:00 minute) and describes a great treatment plan.  She also explains what we can do to avoid getting them in the first place.   

Dr Harter is the Division Chief of Pediatric Dermatology at Children’s Hospital & Medical Center Omaha. She is also an Associate Professor of Dermatology at the University of Nebraska Medical Center.

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children.  Most of her podcasts are targeted towards general pediatric topics and presented in an easy to understand manner.

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Please note this channel does not take the place of advice from your own medical doctor.  If you have any medical concerns, please seek medical attention.

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

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Transcript

Unknown: 0:00

Hello hello welcome to this week's episode of Ask Dr. Jessica I'm your host, Dr. Jessica Hochman. This week I continue my discussion with paediatric dermatologist Dr. Nicole harder. And we talk about two common paediatric skin conditions molluscum contagiosum, and warts molluscum. contagiosum, as its name implies, is extremely contagious and common in children. When a child gets molluscum, or the common Ward, many parents don't know what to do. I feel really lucky to have had the chance to talk to the pull harder and have this conversation recorded because she gives great advice on how to handle these pesky skin bumps. And if you know anyone who may benefit from listening to this episode, I would be so appreciative if you would share it. US spreading the word is what helps us podcast bro. How are you Dr. Harder, I am great excited to be here. And I'm excited to talk about some kind of creepy crawly things here a few days before Halloween. So I thought we would talk about some common contagious skin conditions in children that come up frequently with children so that parents can have an idea what to look for and what to do. So I thought we would start talking about something I see often and that is molluscum. contagiosum. Yes, molluscum contagiosum are moleska as we call it incredibly common Oh my god. So you see this all the time when your office and I see it when it's probably more severe, or it's been going on a really long time. And families really want guidance about what to do for treatment, it's really important to know that all molluscum does go away. It does. But it can take six months, 12 months, 18 months, 24 months, sometimes more. And none of us unfortunately can ever predict how long it will take. Yes, it can spread can spread on a child's body. If they're scratching it, it can spread to their siblings, it can spread to their playmates and friends at school, which is okay, it's going to happen, nothing to be worried about. So harmless, right? It's completely harmless. It's a benign viral skin infection. So it's like a war, it's just a different virus, and kids tend to get it. We've all been exposed to it. So as adults, even if you've never had the bumps, because they causes little pink kind of shiny bumps, they almost look like acne, but sometimes on the skin, or pimple type bumps. We've all been exposed to this virus. So as adults, we don't get molluscum kids get it, their body wakes up, fights it off, and it goes away. And it's gone forever. And so it's incredibly frustrating, but thankfully, not dangerous at all. I actually never knew that that the reason why adults don't get it is because we've been exposed as children. Yeah. That's so interesting. Okay. So and that's great. That's great to know. So early immunity makes a difference for later in life. It does. Yes, it does. And, and just to describe it a little more for parents so they know what to look for. Can you verbally paint a picture of what what malesko looks like on the skin? Yeah, so it's either going to be kind of skin colour to slightly pink, little tiny, how big, maybe smaller than a pencil eraser, maybe a quarter or half the size of a pencil eraser, so pretty small, a couple millimetres, and they can be kind of pink shiny little tiny bumps, they're totally painless, not itchy, they are usually scattered kind of on the tummy, the bath that give me the arms and the legs. They love the fold. So they love the diaper area. They love the armpits, you can get them on the face and neck, but it's a little less common there. And sometimes they look like they have like a little molehill that has a little central Dell in the middle of it. That's a classic kind of textbook term for MLS COMM And then occasionally we'll get really red and puffy and look like there's a little white pus ball, like an athlete bumper, pimple type bump inside of it. That little white ball is actually the viral particle. And so that's where the virus is living, and the body eventually kind of extrudes that and then or molluscum has gone. The Mask of just hanging out on the body for a long time until all of a sudden your immune system wakes up one day and decides, Okay, what's this thing in the skin? Let's fight this off. Then they go away. And they all seem to go away together. I feel like once they do away they all follow suit. Right? Yeah. Once the immune system wakes up to the virus, they all go away and usually pretty quickly over the course of a couple of weeks. Wow. Okay. And I love that you bring up the white bump because so many people that I talked to including even some medical professionals, when they see the white bump or the red, swollen bump, they think it means it's infected. But how often is it truly infected? It's rarely truly infected. We've had a lot of studies on this in paediatric dermatology actually, because they can look angry, they look red and swollen and puffy and in another setting, it could look like an abscess or a skin infection. But this is actually a sign the body's waking up and starting to fight them off and they're going away. So I usually tell families a lot worse and then they're going to get better. So a sign of them. A really, really good sign is that looking angry, red, puffy and swollen they almost never need either topical or oral antibiotic treatment. Is there a go to over the counter? Treatment? If somebody I know you said they go away on their own eventually over time, but a lot of parents, you know, want that to go away faster? Is there an over the counter treatment that you do recommend? So there truly isn't, I hear anecdotal reports. So patients and families telling me about things they tried that seemed to be helpful. And it's all over the place. I would say tea tree oil is the one thing that probably has the most reports behind it. But I think it's important that patients and families understand is that all of these over the counter treatments, including tea tree oil, are trying to generate a slightly irritating response on the molluscum to get the immune system to fight them less can bump off. So I'm always very wary because those irritating substances sometimes are tolerated very well and are sometimes incredibly irritating, and I can't predict that response. So there's really no go to over the counter treatment I actually think is safe and effective. Wow. Okay, so I i do recommend you know, I've I've gone to paediatric conferences where not to not to mention names, but you know, Dima Derm, or con Xero, or even Rene's will be recommended as treatments to speed up Meloxicam disappearing, but you wouldn't recommend those. So, families tell me about this. I'm a DERM. I really don't have much experience with it. When it works. Well, for them. I feel like great, it's fine. I have had some patients get significant irritation from it. I think the vast majority of patients I see it didn't work. But that's also probably why they're coming to see me is because they've tried some things from Alaska, and they're ready to do something else. Now the topical retinoids or the retinae. That can be an effective treatment for molluscum. It's not my go to because it is irritating. And it takes a very, very long time to work weeks or months even. It's also very hard to know when we're putting a substance on an Alaska bump that we know is going to go away on its own. Did the retinae do anything? Or did the molluscum just go away on their own? Right? Okay. Is it but Is it harmful to try these over the counter products? Not harmful to try? I would be careful with the retinae though just because it can cause significant skin irritation. So if you're noticing redness, scaling as the child is itching more now with the treatment, maybe kind of backup back off on that we don't want to cause a worse situation. Is there ever a time that you think it's worth treating moleska? Like let's say I mean, sometimes parents have children have so many, they're all over the body and they're very frustrated. When do you think it is worth seeking a dermatologist for treatment. So it's often the individual kind of patient and family situation based on how frustrated the child is how frustrated the family is, if it's you know, affecting more than one child in the household and it's becoming stigmatising from a social or psychosocial perspective, say they're in dance or gymnastics, and they're, you know, legs and arms are always out. They have malesko all over and they're feeling really self conscious about it. That is a reason to treat of course, but I prefer an in office treatment called Beetlejuice or cam ferritin. But this little painting, it's like a clear nail polish that I paint on each moleska it dries it's not painful, and it creates a tiny blister on each bump in about three or four hours and the family does have to wash it off at home. It is quite effective. Some kids do get some pretty significant blisters from it. I won't lie, but it's usually very, very well tolerated. They do have to come back and see me about once a month to have that treatment repeated until they stopped developing new molluscum No, that's great. Okay, good. So it's good to know. I mean, that's a great these are great tips because if parents don't want to treat it and they want to wait to know it will eventually go away. But if they do want to speed it up for any reason they can see a dermatologist. Yes, absolutely. Okay, great. And, and what about popping them sometimes I've had parents that want to pop the molest gum, so I never I never recommend to pop them because it can there's the risk that it could create true bacterial infection or scarring. For older kids like say teenagers that have a couple localising less come bumps, I will numb them. So put a little injection of lidocaine numbing solution into them less can bump and then I can actually just gently scrape off the entire Moleskine bump. Because I'm getting rid of that little white ball, the viral particle just takes them less can bump with it. I won't do that in young kids or someone with a bunch of moleska because I have to put a shot into each one. It's much much too painful. And I do think there's a slightly greater risk of scarring when you're kind of doing that scraping method. So don't pop them less gum, it could lead to scarring could lead to infection if you really want them treated. Just come on in. Yeah, truth be told, I did see Dr. Pimple Popper. Pop a moleska once and I thought that's not the right thing to do. I would not do that. No, maybe it was an older patient but I would not Papa Blasco. That's good. Thanks for clearing that up for me. Now a couple of psychosocial questions. One is, you know, you're saying you can spread it to to friends. A lot of parents are worried they want to make sure that their kid doesn't spread it to a playmate, do you have any advice for parents in that situation. So I try and provide a lot of reassurance, your child got it from someone who knows who that might be. And they may give it to someone who knows who that might be. And they may have a lot of personal guilt over that. This is part of having children in daycare and in school and in activities, which we want them in. things they can do to minimise that, if there's a way to use a clothing covering, so they can wear long sleeved t shirt or leggings just to cover the physical areas involved. If they're doing something like swimming, trying to use maybe like the long sleeve rash guard sort of swim shirt, and say they're in swim lessons or that age and they use a kickboard or using the swim equipment, get them their own kickboard and their own swimming equipment, so that when they're rubbing up against it in that wet, moist, warm environment, it's just their equipment, and they're not sharing it with someone else, trying to keep bath towels at home separate for siblings. And if you have two children, and one has less come in the other doesn't. Ideally having them not be together until the other the one with less comes molluscum has resolved in a lot of families. That's not an option, right? You're just trying to get kids in the bath at nighttime and I just tell them, you know, be aware of the other one may get molluscum it's okay, you got to do what works for your family. And that's a big part of our my discussions with parents too. And I'm thinking to if the average Moleskine will last anywhere from six months to a year and a half, that's a long time to try to keep sibling separated almost I would say impossible. Yeah, it usually only works if one siblings like 10 and the other one is two, which is the most common scenario. Right? Okay, and then another thing that comes up just to touch upon this, some parents as you because you mentioned that molest can can be in the diaper area, and I know not to bring up something on the sensitive side. But I've had parents that get nervous because molluscum is contagious, and they'll send their child to daycare. And if they notice their child has Meloxicam in the diaper area, they're concerned about another child safety at daycare if there's anything funny happening. And any comments you can make on that. I mean, I just like hearing you say that it is normal to have to find it in the diaper area is it very much like the diaper area. And you know, if you just google moleska, you may see that it can be a sexually transmitted infection. When it happens in teenagers and young adults. It often is a sexually transmitted infection because it's transmitted by close prolonged skin to skin contact. In children, we consider it a routine normal viral rash that does not make my you know my ear stand up or make me feel Wheezy or queasy whatsoever, even in the diaper area. So they may have gotten a trans it could have been transmitted from an older child, someone touching that older child in Alaska and then normal diaper changes for your child. And that would be unfortunate of course and I would hope that would never happen in a daycare situation. But it could easily be what we call just like normal, benign diaper hygiene and diaper care that could have transmitted into that area on the body. Okay, any any other tips of MLS comm that we didn't cover? No, I think I think things I love you're watching Wait, but if you're not going to watch and wait. I like the Beetlejuice treatment I think it's the least painful, least traumatic treatment and I'm all about not traumatising children for skin lesions that are otherwise benign and eventually going to go away on their own such wise words of wisdom. Thank you. Because I actually have seen kids get treated from Alaska where it's blistered. And we're that what we say is like the treatment is worse than the disease. Exactly, exactly. And I never want to be a part of that treatment plan. That's, that's my goal. I want to be part of that treatment plan. Alright, so and then along the same lines as much as GM and other as you mentioned before, how moleska is similar towards words is something else that we deal with a lot commonly in paediatrics, I see it often on the feet on the hands. And it's on the knees. And it's such an annoyance for family. So I thought maybe we could cover words a little bit. In general, how should parents like what should they look out for? How should they think about words? So words, just like molluscum are a virus in the skin and they can pop up especially on hands and feet is one of the most common locations. They can be very frustrating and very hard to treat. And unlike moleska, they can come and go throughout the lifetime. So I'm sure as many of your listeners know you can have worked at any any point in in the lifetime. I think one of the biggest things I'm going to advocate for for kids with words is again, painless treatments. So a lot of providers will use liquid nitrogen or the freezing spray on kids. It's really painful if you've ever had that done to yourself. I had it done to a planar war on my bottom of my foot when I was nine years old. And I literally forcibly ran from the dermatologists office like the parking lot no shoes, anything and I was pretty mellow kid, like screaming remember, I still remember all of this. Yes, it was, it was horrible. I will not do that to a child to a teenager that says, Yes, I'm willing to do whatever it takes to get this word away. We'll talk about it as part of the treatment process. But there is a prescription topical compound that I think is kind of magical for words. It's called Work peel. It's also made by several other compounding pharmacies. But there's an over the counter treatment for words called salicylic acid, you can buy it as compound W or Dr. Scholes. What this prescription compound is, is a much higher strength of salicylic acid plus another prescription compound, it is so much more effective, and it's generally quite painless. The compounding pharmacies set up payment with the family. Unfortunately, this is not covered by insurance, it's usually between 60 and $80, for two of it, which will last a good long while they get shipped to your house, and then you put on the ward each night until the word literally peels off. Now it does work and it works very well. So sometimes that means that the skin around the word can get a little irritated or pili. So I tell families to put some Vaseline or Aqua for around the war to protect the normal skin, you put a little dab of this word compound on the word and then you cover it and duct tape. It's actually part of the treatment. I know I sound crazy, the duct tape is part of the treatment. You do this every night, you take out the duct tape in the morning, and then a couple weeks towards likely just going to peel away. And I think it's the most painless treatment option we have for warts. And I do think especially if warts are on the fingers, it is important to get control of them especially because in young kids, their fingers are often going fingers are often going on their face or in their mouth. And you can transmit them to the facial area and they're much much more challenging to treat. And so when you say you know that compounding pharmacy, just so so people are aware, that means that you'd have to go to the doctor and get a prescription for it, right? Yes, absolutely. So if you're really looking to do something at home, the best thing you can do at home, is get that over the counter salicylic acid, put a little dab on the ward and put a piece of classic duct tape over the top I used to I usually say classic silver duct tape. But duct tape comes in all sorts of like Hello Kitty and Paw Patrol and whatever it might be these days, but you need to put duct tape on top of it. The reason for that is the salicylic acid helps that out the word it takes words are like a thick, thick mountain of skin, but the word virus causes the skin the top layer this skin epidermis to get super thick, the salicylic acid helps the net out. And then every time you remove the duct tape, it peels off that dead layer of work. So it's really a part of the treatment. And there's a lot of good evidence about it. Sometimes you can just use duct tape for words. But I think if you did the salicylic acid and duct tape, and you find the word early in our treatment early, it's going to be much, much more effective. And maybe only take a couple of weeks to go away. Once a word is really established. It can take many, many rounds of treatments, many rounds of treatments and years. We're talking 2456 years to go away. Wow. Okay. Yeah, I've seen that before. Definitely. Where words are very stingy. They like to get comfortable. Yeah, so Okay, so and I know there's different percentages of salicylic acid and there's a range over the counter, is there a first percentage that parents should look for 17 and 20% is what I routinely recommend to start with, there is a one brand that makes up 40% That I do like, especially for larger thicker words, especially planters words because the bottom of your feet, it's really, really thick skin to begin with. So anywhere between the 17 and 40%. But I think the 17 to 20 is a good starting point. Okay, and then they come in so many, you know, formulations, you can get the band days you can get the paint on. Is there a favourite? Within that that you like? Yeah, I personally like the kind where you can paint it on because then I want to put the duct tape on top of it. The one impregnated in a bandaid is convenient that you're not getting kind of that exfoliative action from taking off the duct tape. Okay, thank you. I mean, this may sound naive on my part, but I've always recommended duct tape but I thought the I knew was better than placebo, but I thought it was working because it was somehow smouldering the virus. And it's because it peels off the skin layer after the dead skin layers. Oh, that's great. Thank you. Okay. And then the compounding substance. Is it salicylic acid, the one that the doctor would prescribe it salicylic acid do you do the 40% in that case? No, the compound it is actually it's a 70% salicylic acid and the second medication is called Five Flora uracil, which have a family looks up. It's gonna look really scary because we actually use it as a cancer and chemotherapy cream for people that have pre cancers and early skin cancers. The reason it works for chemotherapy on the skin is because it targets rapidly dividing cells will award also causes rapidly dividing cells. So we're not giving your child chemotherapy in the true sense of the word. It's just one other medication that really targets the the bulk of where the word is coming from, which is those rapidly dividing cells. Would you ever recommend like let's say there's a really there's a Plants are worth that's been there for years. Do you ever think there's a role to do multiple treatments like the liquid nitrogen, you know, to freeze it and to do the salicylic acid and to do the duct tape? Absolutely, especially in larger and more stubborn words that have been there for a long time. Usually it's multimodal modality therapy. If I have an older patient who is you know, that says, Yes, I'm willing to endure some discomfort, I will freeze it I will do, there's a certain injection I can do to actually stimulate the body's immune system to hopefully find out the word. So I'll freeze I'll do injections, and I'll have them doing either the salicylic acid over the counter, or the prescription compound at home. And then they're still coming back to see me usually once once a month so we can get control of it. But I've always learned that the more the more you make that word uncomfortable on your body, the better that you can treat it, the better. It's so true. And what about avoidance? Is there anything parents should think about with their children to avoid getting awards? Or is it just sort of you know, it is what it is? A little bit of both. I think one thing you can do is have have good foot care practices, especially if you're around a pool deck having always having shoes on, and especially in locker rooms, always having shower shoes, flip flops on in the locker room. Large, moist, wet, damp, shared environments is where wart virus loves to live. So really in those locker rooms and shared pool decks, always trying to have just a cheap pair of flip flops around so they can try and prevent get into war inoculate into their feet. It's harder with hands because that's usually more skin to skin contact. So we just do our best good hand washing right here. That's fantastic advice. Thank you so much. I'm so appreciative of your time of course. It was fun chatting with you. You taught me a lot so it was so much fun. I really appreciate being part of it.