Molluscum

Dear Lisa,

My daughter’s friend has Molluscum. She visits our house regularly and we have a swimming pool. I do not want to make her feel bad and exclude her, but I am worried that my daughter will catch the rash if she goes in the pool. She is a good friend and I don’t want to break up their friendship by not letting them play together. How is Molluscum spread? Can my daughter catch this?

“Friend with Molluscum”

Dear “Friend with Molluscum”,

Molluscum contagiosum is a viral skin infection that is caused by a pox virus. Molluscum is common in childhood and presents as flesh colored, waxy bumps with umbilicated tops. In children the rash is typically found on the trunk and extremities. The size of the bumps range from 2-6 cm and may be larger in people that are immunosuppressed, such as in people with HIV. (1)

Transmission occurs from person to person by direct skin to skin contact or from contact with shared objects such as towels, gymnasium equipment and locker room benches. There have been some recent reports of swimming pool use and Molluscum contagiosum. (1) The incubation period is 7 to 60 days, so if your daughter does catch this from her friend, it might not show up for a couple of months.

Generally, Molluscum contagiosum is a benign disorder which usually is asymptomatic and rarely has complications. Complications include an eczema like reaction which occurs in about 10% of cases. In people with dark skin the healed lesions leave behind an alteration in the color of the pigment, resulting in a white or brown flat spot. Very rarely the lesions leave a chickenpox-like scar. (1)

In regards to your daughter’s friend, this is a very touchy situation. If you eliminate her from playing at your home or playing in your pool you may cause her to be insulted and embarrassed. On the ohter hand, if she has close contact with your daughter, shares clothes or towels, or swims in the pool, she may spread the disease. Although the obvious thing to do is to avoid this friend in order to stay free of Molluscum this may not be necessary if you take the proper precautions. Besides, separating the children may put a strain on their relationship.

Perhaps, engaging in activities together that do not involve intimate contact would be a better choice. You can still maintain their friendship by having them play together in activities that do not involve skin to skin contact such as going to the movies, going bowling or doing arts and crafts together. If the lesions are covered and not exposed there is no reason to be concerned about catching the disease. On the other hand, if the lesions are exposed (located on the arms or face) and the children engage in close contact such as hugging other measures need to be taken. You can gently ask her mom to cover the lesions with a band-aide or tight fitting shirt. Most parents are sensitive to the spreading germs to other children and should not be insulted by this.

The important thing to remember is that even though the incubation period for catching this skin condition usually is 2 to 7 weeks, it may take up to 6 months to manifest itself. So in reality, your daughter may already have been exposed and any attempts to separate the children at this point might not make a difference. Additionally, Molluscum contagiosum typically lasts 9 months; which is a very long time to avoid a good friend. Since Molluscum is a very common childhood rash, if your daughter doesn’t catch it from her friend, she may catch it from another child.

Once you examine all of the scenarios, you can make an informed decision knowing how Molluscum contagiosum is spread. If you decide to continue to have your daughter’s friend in the pool, it would be a good idea to teach your daughter not to share towels. So as not to single out your daughter’s friend, a general rule to not share towels with all guests is a good practice to follow. This will protect all children because many skin infections can be spread this way. Also, discourage the children from borrowing or sharing clothes, and avoid dress up games where the children try on different play outfits and play out a story.

(1) Dermatologic Look –Alikes. Molluscum contagiosum. The Clinical Advisor. 2006(April):98.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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