The Hidden Impact of Molluscum Contagiosum: A Survey of Caregivers’ Experiences with Diagnosis, Treatment, and Impact on Quality of Life. Pearl Kwong MD, PhD1, Adelaide A. Hebert MD2, Collette Utley DNP, NP-C3, Melissa Olivadoti PhD4
Objective: Molluscum contagiosum (molluscum) is considered benign and self-limiting. However, the caregiver and patient experience largely remains a mystery. This online survey aimed to collect caregivers’ views on their experiences with molluscum infection in their children, including diagnosis, treatment, and the impact of the virus on the caregivers’ and their child’s life.
Methods: Parents, caregivers, and/or legal guardians (ages 18+, 20% male and 80% female) of children diagnosed with molluscum in the past 4 years (ages 3-16 years of age) answered a 15-minute paid online survey with questions about their experience with molluscum.
Results: Caregivers (n=150) were mostly Caucasian (85%), 25-44 years of age (87%) and had at least one child with active molluscum (75%) at the time of the survey. The average number of health care providers (HCPs) consulted for molluscum was 1.95 and diagnosis was made by a variety of HCP types. The spread of molluscum to ≥ 1 child in the household was reported by 60% of caregivers in multi-child households. The average number of treatments used were 2.36 including HCP-administered treatments and consumer products. Caregivers reported moderate to major impact on their lives (62%) or their child’s life (74%) due to molluscum.
Limitations: Questions were not validated, recall time was up to 4 years.
Conclusions: Molluscum patients may receive a diagnosis from many sources. Caregivers may utilize more than one treatment modality to help clear the infection including consumer products. Molluscum can cause an impact on quality of life for affected children and their caregivers.
Epidemiology of molluscum contagiosum in children: a systematic review. Olsen JR, Gallacher J, Piguet V, et al. Fam Pract. 2014;31(2):130-136.
- Background. Molluscum contagiosum (MC) is a common skin condition that primarily affects children, a common reason for presenting in primary care and is commonly seen in children presenting with other conditions in primary and secondary care. It is usually asymptomatic but can present with pain, pruritus, erythema and bacterial superinfection.
- Design and setting. A systematic literature review of bibliographical databases on the prevalence, incidence, risk factors, age distribution and association with other conditions for MC in children.
- Results. Data on the epidemiology of MC is largely of poor quality. The largest incidence is in children aged between 0 and 14 years, where the incidence rate ranged from 12 to 14 episodes per 1000 children per year. Incidence rates in the UK were highest in those aged 1–4 years. Meta-analysis suggests a point prevalence in children aged 0–16 years of between 5.1% and 11.5%. There is evidence for an association between swimming and having MC and MC is more common in those with eczema; however, there is little evidence for other risk factors.
- Conclusions. MC is a common condition, with the greatest incidence being in those aged 1–4 years. Swimming and eczema are associated with the presence of MC, but the causal relationships are unclear. There is a lack of data regarding the natural history of MC and published data are insufficient to determine temporal or geographic patterns in incidence, risk factors, duration of symptoms or transmission between family members.
- Time to resolution and effect on quality of life of molluscum contagiosum in children in the UK: A prospective community cohort study. Olsen JR, Gallacher J, Finlay AY, et al. Lancet Infect Dis. 2015;15(2):190-195.
- Molluscum contagiosum is one of the 50 most prevalent diseases worldwide, but scarce epidemiological data exist for childhood molluscum contagiosum. We aimed to describe the time to resolution, transmission to household child contacts, and effect on quality of life of molluscum contagiosum in children in the UK. Between Jan 1, and Oct 31, 2013, we recruited 306 children with molluscum contagiosum aged between 4 and 15 years in the UK either by referral by general practitioner or self-referral (with diagnosis made by parents by use of the validated Molluscum Contagiosum Diagnostic Tool for Parents [MCDTP]). All participants were asked to complete a questionnaire at recruitment about participant characteristics, transmission, and quality of life. We measured quality of life with the Children’s Dermatology Life Quality Index (CDLQI). Participants were prospectively followed up every month to check on their recovery from molluscum contagiosum and transmission to other children in the same household, until the child’s lesions were no longer visible. The mean time to resolution was 13·3 months (SD 8·2). 80 (30%) of 269 cases had not resolved by 18 months; 36 (13%) had not resolved by 24 months. We recorded transmission to other children in the household in 102 (41%) of 250 cases. Molluscum contagiosum had a small effect on quality of life for most participants, although 33 (11%) of 301 participants had a very severe effect on quality of life (CDLQI score >13). A greater number of lesions was associated with a greater effect on quality of life (H=55·8, p<0·0001). One in ten children with molluscum contagiosum is likely to have a substantial effect on their quality of life and therefore treatment should be considered for some children, especially those with many lesions or who have been identified as having a severe effect on quality of life. Patients with molluscum contagiosum and their parents need to be given accurate information about the expected natural history of the disorder. Our data provide the most reliable estimates of the expected time to resolution so far and can be used to help set realistic expectations.
The Hidden Impact of Molluscum Contagiosum: Survey of Caregivers’ Experiences with Diagnosis and Management Pearl Kwong, Adelaide Hebert, Collette Utley, Melissa Olivadoti Maui Derm Connect Dermatology Congress (Virtual) September 23-27, 2020
Objective: Molluscum contagiosum (molluscum) is a common pediatric viral skin infection. While this condition is considered benign and self-limiting, molluscum can last for months to years and cause itching and pain. The experience in caring for a child with molluscum largely remains a mystery, with few studies published on the topic. This online survey aimed to collect caregivers’ views on their experiences with molluscum infection in their children.
Methods: Parents, caregivers, and/or legal guardians of children (ages 3-16 years) who were diagnosed with molluscum in the past 4 years were recruited to answer a 15-minute paid online survey. Margin of error at the 95% confidence interval for the total sample was ± 7.7%. Survey questions inquired about the type of health care provider (HCP) consulted, diagnosis, treatment, and how severely molluscum impacted the caregiver and the child.
Results: Respondents (n=150) were mostly Caucasian (85%), 25-44 years of age (87%), and had at least one child with an active infection (75%). Median household size was 4 people. The median age of children in the home was 8 years. Most respondents saw at least 2 types of HCPs for their child’s molluscum. Diagnosis was completed by Pediatrics (49%), Family Practice (37%), Dermatology (34%), Infectious Disease (23%), and/or Emergency Room (21%). Spread of molluscum to ≥ 1 child in the household was reported in 60% of caregivers. Most caregivers were offered treatment options by the health care provider (61%) vs. allowing the disease to remit on its own (39%). Most caregivers reported moderate to major impact on their lives (62%), 70% agreed with the statement that molluscum kept their child away from doing things they love, and 62% agreed they worried what others thought of their child having molluscum. Many respondents (47%) considered squeezing or removing lesions themselves at home and 31% utilized this strategy. The most common approaches to treatment were home remedies (43%) and molluscum treatments purchased from Amazon.com or a drug store with no Rx required (41%), followed by cryosurgery (41%), cantharidin (39%), and curettage (31%). The average number of treatments used was 2.36.
Conclusions: Results indicate that molluscum patients receive diagnoses from many HCP types, often visiting more than one HCP. Many patients do not receive treatment, and those that do receive treatment are likely to use more than one modality in attempt to clear the infection. Caregivers were likely to attempt to try at-home remedies or use unproven/unapproved remedies, as well as attempt to disrupt lesions themselves, creating opportunities for autoinoculation and spread of the infection. Not surprisingly, spread to another child in the household was common. Finally, a moderate to high impact on quality of life for caregivers and an impact on activities for their children with molluscum was reported. This suggests that while physically benign, molluscum has an emotional impact patients and their caregivers, with concern over a negative social stigma.
Funding Statement: Funding for this survey was provided by Verrica Pharmaceuticals Inc., in conjunction with Whitman Insight Strategies.
- Infectious Diseases Associated With Organized Sports and Outbreak Control. Davies HD, Jackson, MA, and Rice SG. Pediatrics. 2017;140(4):e20172477.
- Participation in organized sports has a variety of health benefits but also has the potential to expose the athlete to a variety of infectious diseases, some of which may produce outbreaks. Major risk factors for infection include skin-to-skin contact with athletes who have active skin infections, environmental exposures and physical trauma, and sharing of equipment and contact with contaminated fomites. Close contact that is intrinsic to team sports and psychosocial factors associated with adolescence are additional risks. Minimizing risk requires leadership by the organized sports community (including the athlete’s primary care provider) and depends on outlining key hygiene behaviors, recognition, diagnosis, and treatment of common sports related infections, and the implementation of preventive interventions.
- Molluscum contagiosum virus infection: Chen X, Anstey AV and Bugert JJ. Lancet Infect Dis. 2013; 13(10):877-888.
- Molluscum contagiosum virus is an important human skin pathogen: it can cause disfigurement and suffering in children, in adults it is less common and often sexually transmitted. Extensive and persistent skin infection with the virus can indicate underlying immunodeficiency. Traditional ablative therapies have not been compared directly with newer immune-modulating and specific antiviral therapies. Advances in research raise the prospect of new approaches to treatment informed by the biology of the virus; in human skin, the infection is localized in the epidermal layers, where it induces a typical, complex hyperproliferative lesion with an abundance of virus particles but a conspicuous absence of immune effectors. Functional studies of the viral genome have revealed effects on cellular pathways involved in the cell cycle, innate immunity, inflammation, and cell death. Extensive lesions caused by molluscum contagiosum can occur in patients with DOCK8 deficiency-a genetic disorder affecting migration of dendritic and specialized T cells in skin. Sudden disappearance of lesions is the consequence of a vigorous immune response in healthy people. Further study of the unique features of infection with molluscum contagiosum virus could give fundamental insight into the nature of skin immunity.