Pictorial case study - Papules on a child

A mother is worried about the appearance of papules on her child's chest.

The presentation

A mother came to see me with her otherwise healthy two-year-old. She was very concerned about the crop of umbilicated pink/yellow papules that had developed on her child's chest and seemed to be spreading.

There was no concern about secondary infection or lesions on the eyelids that could lead to conjunctivitis. The childminder had refused to accept the child until 'something was done about it'.

The child had previously had a mild atopic eczema, which had been kept well under control with emollients and the occasional application of a corticosteroid cream when necessary.

Differential diagnoses
  • Warts
  • Basal cell carcinoma
  • Keratoacanthoma
  • Milia
  • Fibrous papules
  • Herpes simplex or shingles
  • Dermatitis herpetiformis

The management

There seemed no doubt about the diagnosis of molluscum contagiosum. The mother was reassured and told that exclusion from school, nursery or childcare is not recommended in such cases and the condition should settle spontaneously in the next few months.

Molluscum contagiosum is a common condition. It may occur at any age, but is most often seen under the age of 15, particularly in the preschool years.

Where lesions become confluent, plaques may form and in cases of immunodeficiency, sarcoidosis or lymphocytic leukaemia, there may be more widespread and persistent lesions. It is caused by a DNA pox virus and transmitted by direct skin contact or sharing of things such as towels or baths.

The condition normally resolves spontaneously and is self-limiting. Treatments are not usually recommended because they may be painful or upsetting for young children.

  • Dr Watkins is a retired GP in Hampshire

Resource

Health Protection Agency. Guidance on infection control in schools and other childcare settings (2010).

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