Dr. Nur Aileen Wee, Consultant Paediatric & Paediatric Dermatologist Growell Baby and Child Specialist Clinic Ampang
I would like to highlight two common viral skin infections in children. They are mainly harmless and usually have no symptoms. However, aesthetically, they can be unsightly and disturbing, especially to the parents.
Viral Wart
Viral warts are common skin infections. They are usually small, round, firm, rough bumps on the skin. Viral wart is common in kids and can affect any part of the body, but commonly seen around the fingernails, fingers and feet. They can be skin-coloured, darker or lighter than the surrounding skin and sometimes they have tiny black dots in them, which are clotted blood vessels. Most warts don’t hurt, but those on the soles or get bumped a lot can be painful.
Warts are caused by papillomavirus of different strains and it only affects the skin. Your healthcare provider is usually able to diagnose by looking at the warts. Biopsy is not usually required. Most viral warts self-resolve in weeks to months without treatment. Warts may be difficult to treat and may recur.
There are different kinds of warts:
1. Common Warts
Common wart on the finger1
Small, hard dome-shaped bumps with rough surfaces, greyish-yellow or brown in colour, usually found on hands, fingers, knees, elbows or at sites of cuts/ scratches.
2. Flat Warts
Flat warts on the forehead and its features2
Tiny pinhead warts, surface smoother than other kinds of warts, and have flat tops, mostly on faces, but can grow anywhere and can appear in clusters.
3. Plantar/palmar Warts
Palmar warts and its features2
Found on the bottom of the foot, and/ or on the palms. They can cause discomfort/ pain.
4. Filiform Warts
Filiform wart on the eyelid2
Finger-like shapes, are usually skin-coloured and often grow on or around the mouth, eyes, or nose.
5. Periungual Warts
Periungual wart below the big toenail3
Typically appears as thickened skin around the nails and can cause fissures (painful splits in the skin).
Treatment depends on the following:
- type of wart
- how long they have been in place
- location of the wart
- how many is growing
Some treatment modalities may cause pain & burning in the area treated. Thus treatment options need to be properly discussed with your doctor.
Treatment options include one or more of the following:
- Topical irritant – putting salicylic acid/ other medicine on the wart
- Freezing the wart with liquid nitrogen
- Applying an electrical current on the wart (electrocautery)
- Cutting out (excising) the wart
- Removing the wart with laser surgery, for example, pulse dye laser
- Imiquimod cream helps to stimulate the body’s immune system so that it will clear the bumps. It is commonly used in genital warts in adults. However, safety and efficacy have not been established in children younger than 12 years of age.
Finally, what can parents do to help?
What can I do to prevent skin warts in my child?
- warts can spread to other parts of the body or other people
- it can spread by skin to skin-to-skin contact
- may be spread by towels/ other personal items
- you can help to prevent the spread.
Make sure your child:
- does not touch the wart to other parts of his/ her body
- does not touch the wart on other people
- does not share anything that touches his/ her wart, e.g. towels
- wears socks or slippers if he/ she has warts on the bottom of the feet
Molluscum Contagiosum
Molluscum contagiosum is another frequently seen viral skin infection in children. It only affects the skin and is caused by pox virus. The virus causes a rash after it enters a small break in the skin. Small bumps usually appear 2 to 6 weeks after that. Viruses spread from skin touching skin; and touching objects that have the virus on them such as towels, toys, clothing, and bedding. Molluscum contagiosum is common in healthy children. However, they are also seen in close contact sports athletes, and adults with suppressed immune systems.
They present with small, round, skin-coloured or white bumps, ranging from 2 to 6 mm, and occasionally exceed 10mm. They are usually soft and smooth, some with dents in the centre. Molluscum are usually not itchy and not painful. They often provoke localised eczema, especially in children with existing atopic eczema. As it resolves, it usually becomes red (inflamed) and leaves a temporary scar. (Figure 6 and Figure 7)(5)
Multiple white/ skin/ pink coloured bumps5
Numerous white bumps and some inflamed. Underlying skin shows dry scaly patches5
Most dermatologists can diagnose molluscum contagiosum just by looking at the rash. No further test is usually needed.
Treatment is the main interest of most parents. However, the following considerations need to be taken before choosing appropriate treatment:
- patient overall health
- numbers of molluscum bumps
- site of the molluscum bumps
- age of the child
Importantly, no matter which treatment is used, it will take time.
Conservative, or do nothing is an option. Molluscum can resolve on its own without treatment. New bumps can appear while the old ones disappear. They usually take about 6 to 12 months (occasionally longer, reported to take up to 2 years) to completely clear. Treatment is usually recommended by dermatologists for patients who have:
- chronic skin condition such as atopic eczema
- weakened immune system
- extremely bothersome molluscum
Treatment should be used with dermatologist advice and monitoring. Parents are advised not to purchase over-the-counter medicine and use it without a prior doctor’s consultation.
Physical therapy is commonly recommended as a treatment modality. They include:
- prick out the centre with a sharp stick or sterile needle
- topicals (off-label use) to irritate skin surface and break the bumps
- curettage
- cryotherapy
- removing the wart with laser surgery, for example, pulse dye laser
Imiquimod cream is used in adults and off-label use in children. As I have mentioned in the section above, safety and efficacy have not been established in children younger than 12 years of age.
Finally, what can parents do to help?
To avoid molluscum and other skin infections, have your kids follow these tips:
- wash hands well and often with soap and water
- do not share towels and clothing
- do not touch or scratch bumps/ blisters on their skin/ other people’s skin
Molluscum contagiosum rashes don’t usually leave scars or have long-term consequences.
