Doctors get calls about warts on a fairly regular basis. Another common reason for those calls is molluscum. Both are viral skin infections that can spread and usually clear eventually, but they come from different viruses and look a little different.
Imagine that the body is a castle that has guards, but somehow these tricky little viruses snuck through the defense system and are already at the castle walls.
Both viruses have figured out ways of staying under the immune system’s radar while they reproduce in the skin. Eventually, however, the immune system usually catches on. The guards are still on duty; these particular intruders just take a while to get their attention. Time will ultimately take care of them, even if you do nothing.
What are warts?
Warts are caused by human papillomavirus (HPV). HPV has tons of strains. In this post, we are talking about the strains of virus that cause benign warts (NOT the HPV types associated with cancer that are targeted by the HPV vaccine).
The virus gets into the deeper layers of the skin through tiny breaks, sometimes so small you can’t see them, and infects the cells that make new skin. HPV then essentially hijacks those cells and encourages them to keep growing, producing the thickened, rough mound of skin we recognize as a wart. The virus is particularly clever at staying under the immune system’s radar, which is one reason a wart can sit there happily for months or years before the body finally recognizes it and clears it.
Warts have an easier time getting into skin that is not intact. If your child has eczema or is a nail biter, they are more prone to warts. Common warts often show up on hands, fingers, or knees; those around the nails are called periungual warts.
Warts on the soles of the feet are called plantar warts. Pressure from walking can flatten them and make them sore. Being on the bottom of the foot doesn’t automatically mean a wart needs a specialist, but pain or trouble walking is a good reason to get help from a pediatrician, podiatrist, or dermatologist.
Treating warts at home
You don’t necessarily have to treat a wart that isn’t bothering your child. Remember, many go away on their own. If you would like to move things along, over-the-counter salicylic acid is a reasonable place to start.
Salicylic acid works by gradually removing the layers of skin containing the wart. Soaking the wart first and gently filing away softened dead skin with a disposable emery board every few days can help the medicine penetrate. The point is to remove dead skin, not to make the wart sore or bleed. Use the board only on the wart and discard it afterward so you don’t spread the virus elsewhere.
17% or 40%? Liquid or patch?
The wart-remover aisle can make this feel more complicated than it needs to be. There are two things to consider: how strong the medicine is, and how you’ll keep it on the wart.
For a small common wart without much thick skin over it, 17% salicylic acid liquid is a reasonable starting point. You dab small amount directly onto the wart and let it dry. This can be handy when a patch won’t fit well or keeps falling off.
For a thick, callused wart, especially on the bottom of the foot, a 40% patch may be useful. The medicated part needs to fit the wart without covering the healthy skin around it. A patch is convenient only if it stays put; liquid may be easier for a small or awkwardly placed wart.
A higher number doesn’t guarantee a faster cure. Choose something appropriate for your child’s age that you can apply consistently, and follow that product’s directions for how often to use or replace it.
Dry the area after soaking and before applying the medicine. Some softened skin peeling off is normal. Be patient: treatment usually takes weeks to months.
Don’t use wart-removal acid on the face, genitals, or broken skin, or on a bump you aren’t sure is a wart. Children with diabetes, poor circulation, or a weakened immune system should have pediatrician guidance before home treatment. If the wart is near a nail, the surrounding skin is sensitive or affected by eczema, or you’re treating a young child, ask your doctor which product to use. Pain, bleeding, or raw skin means it’s time to stop and check in…not move up to something stronger.
There are loads of other suggestions out there. Natural remedies such as tea tree oil have limited evidence and can irritate the skin. We will equate them to using a watering can to fight a fire. The OTC wart patches are your fire extinguishers. The dermatologists and podiatrists have fully equipped fire trucks! Fortunately, a quiet little wart doesn’t always need the fire department.
Treating warts in the office
If home treatment isn’t helping, or a wart is painful or bothersome, go ahead and make an appointment to evaluate treatment options with your pediatrician. It is fully possible that the home treatment will take care of it while you wait, and then you can just cancel the appointment (of course, give the office plenty of warning).
If you do end up at the doctor, they will base the treatment on your child’s age, the wart’s location, and what your child can tolerate. Freezing with liquid nitrogen, called cryotherapy, is one option, especially for older kids. It feels very cold, which can be uncomfortable, but it’s quick. It often requires several visits.
For stubborn warts, doctors sometimes use cantharidin (“beetle juice”… fun fact, this is a substance secreted by blister beetles), which causes a controlled blister beneath the wart. Application is often painless, but the blister can be very itchy and then sore later, and repeat treatments may be needed.
Some treatments injure the infected skin or create local inflammation, which may also help the immune system recognize HPV. Think of that part as an “Intruder Alert” signal to the body. But the treatments don’t all work the same way: salicylic acid primarily removes infected skin, while freezing directly damages it.
What is molluscum?
Now that you have learned more than you ever wanted to about warts, it is time to alert you that sometimes you are dealing with something different. If you are seeing clusters of little bumps, another possibility is molluscum (muh-luhs-kum) contagiosum. It can look like a collection of tiny warts, but it is a separate infection.
Molluscum is caused by a completely different virus called molluscum contagiosum virus, a member of the poxvirus family. Rather than stimulating the skin to build a thick, rough wart, molluscum virus turns infected skin cells into little virus-producing factories. As those cells grow and fill with viral material, they form a characteristic smooth, pearly bump with a tiny dimple in the middle. That waxy white material you sometimes see inside a molluscum bump contains infected cells and lots of virus, which is why scratching, popping, or picking at one bump can spread new bumps nearby.
Often the only sign is pink or flesh-colored bumps on the skin. These can appear almost anywhere, though usually not on the palms of the hands or the soles of the feet. Many people get about 10 to 20 bumps; a person with a weakened immune system may have many more. Bumps can take weeks or months to appear after exposure.
When the bumps appear on the skin, they often:
Begin as small, firm, dome-shaped growths.
Have a surface that feels smooth, waxy, or pearly.
Are flesh-colored or pink.
Often have a dimple in the center. The dimple may be filled with a thick, white substance that is cheesy or waxy.
Are painless, but some bumps itch a little
Many parents think they’re bug bites at first, but once they stay for weeks unchanging they realize that’s not the case
Molluscum bumps may become red, swollen, or crusty shortly before they disappear. That can look alarming, but it is often a sign that the immune system has finally noticed the intruder. Increasing pain, spreading redness, or pus deserves a call, though, because infection can look similar.
Managing molluscum
Like warts, this condition usually goes away by itself, often within a year, though it can take longer. If the bumps aren’t bothering your child, watching and waiting is a reasonable option. Having bumps after a month or two doesn’t, by itself, mean your child needs a specialist, unless the bumps are itchy, spreading, or causing trouble with eczema, or your child is bothered by them. At that point it is worth seeing what treatment options are available.
Don’t squeeze, pick, or file these bumps with an emery board; that can spread the virus. We know they look irresistible to pop…because hey, there’s white stuff inside. Resist!
Treatment
Treating surrounding eczema and itch can help cut down on scratching/spreading.
Cantharidin is one office treatment for molluscum, too. YCANTH is FDA-approved for adults and children age 2 and older and is applied by a health care professional. Follow the doctor’s instructions about washing it off and caring for the treated skin. It can’t go on the face or genitals without dermatologist oversight.
There are lots of internet “cures” for this, including coating the body with silver… but they may waste time and money and can harm the skin.
Are there benefits to treating early once you have a diagnosis?
Sometimes. Neither warts nor molluscum has to be treated…your immune system will eventually clear most of them on its own. But there can be advantages to treating when there are only a few spots.
For molluscum, early treatment may reduce the opportunity for a child to scratch the bumps and spread the virus to other parts of their own skin. This can be especially helpful for children with eczema, who sometimes get dozens of lesions once molluscum takes hold.
For warts, smaller and newer warts may be easier to treat than large, thick, longstanding ones, although treatment still takes patience and there is no guarantee that starting early will make them disappear quickly.
So there is no emergency to treat either condition. But if lesions are multiplying, being picked at, causing discomfort, worsening eczema, or simply bothering your child, there is also no particular advantage to waiting.
How they spread
Both infections can spread through skin contact with obvious lesions, and scratching or picking can move the virus to other areas of the body. People can get molluscum by sharing towels or clothing; shared sports equipment and mats can also be a route of spread.
Unfortunately, folks can get molluscum more than once; having a prior case doesn’t guarantee immunity.
Keep hands off the bumps as much as possible (bandages help keep hands off the bumps and seem to stop the spread), wash hands after touching or treating them, and don’t share towels, washcloths, razors, or wart-filing tools. Cover exposed bumps with clothing when practical. Wearing sandals in communal showers and locker rooms can help reduce exposure to wart viruses.
You don’t need to spray every shoe, sock, and surface with Lysol. Focus on those practical precautions and routine cleaning. For shared baths, the concern is contact with bumps and shared washcloths or bath items; separate bathing can make those contacts easier to avoid, but a total ban isn’t the central prevention strategy.
Kids with molluscum can generally still swim. Cover visible bumps with a waterproof bandage when practical, and avoid sharing towels. Molluscum appears to spread more readily through direct skin contact and shared items than through the pool water itself.
Will siblings likely get it?
Maybe, but it’s not inevitable. Both warts and molluscum can spread between siblings through direct skin-to-skin contact or shared items, but plenty of siblings never develop them.
Molluscum tends to spread more readily between young kids, especially when they share baths or towels, wrestle or cuddle, or when a child scratches or picks at the bumps (have you ever met a child that didn’t scratch or pick?) Children with eczema may be particularly susceptible because the virus has an easier time getting through an irritated skin barrier.
Common warts can also spread between siblings, but usually not from casual household contact alone. HPV generally needs an opportunity to enter through a small break in the skin. Nail biting, picking at a wart, eczema, and sharing items that rub directly against a wart can all make transmission more likely.
You don’t need to quarantine siblings or disinfect the entire house. Focus on the easy things: discourage picking and scratching, don’t share towels or items like nail clippers, keep irritated or easily contacted bumps covered when practical, and keep eczema under good control.
Conclusion
If you aren’t sure what a bump is, start with your child’s usual clinician. Check in if it is changing quickly, bleeding without being picked, painful, interfering with walking, or showing signs of infection. Bumps near the eye or on the genitals, and bumps in a child with a weakened immune system, also deserve medical guidance.
For a stubborn wart that isn’t improving with consistent home treatment, or molluscum that is spreading or bothering your child, a non-urgent appointment makes sense. Ordinary childhood warts are benign; the reason to evaluate an unusual growth is to be sure it really is a wart. A familiar, comfortable bump doesn’t become an emergency simply because it has been there for a month or two.
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