Now that school is back in full swing, children are in close contact with one another. They are engaging in sports, sitting in proximity in the classrooms and lunchrooms, sharing lockers, etc. There are four broad categories of skin infections that may be transmitted from one child to another: viral, bacterial, fungal and parasitic infections.
Pediatric patients present to Christie Clinic with viral infections daily. Warts, or verruca, are one of the most common viral infections and affect approximately 7% to 10% of the population. They are small, benign growths caused by the human papillomavirus (HPV). Common warts, verruca vulgaris, usually occur in patients between the ages of 5 and 20 years. There are many different strains of HPV that cause different types of warts. While warts themselves are not cancerous, some strains of the virus (not usually associated with common warts) are oncogenic. There is a vaccine available to pediatric patients, human papillomavirus 9-valent vaccine or Gardasil 9. It helps protect against 9 strains of HPV that are associated with certain types of cancer. It is not efficacious in preventing the common wart.
Another common pediatric viral infection is molluscum contagiosum (MC). Molluscum contagiosum is a self-limiting skin infection caused by a strain of the Poxvirus. Most lesions regress spontaneously within 9 to 12 months. However, this skin infection can be embarrassing for the student and drives parents and patients to seek treatment. MC presents as discrete, flesh-colored “bumps” with a depressed center. They vary in size from 2 to 5 mm in diameter. They spread by touching and scratching. They can be transmitted through swimming pools as well.
Treatment for common warts and molluscum contagiosum can be frustrating for patients and parents as treatment is often tedious and uncomfortable. With children, therapy is aimed towards the least painful option and non-scarring. Each therapy discussed has both advantages and disadvantages within the pediatric population. Therapies available include topical salicylic acid, cryotherapy (liquid nitrogen) and topical cantharidin (“beetle juice”). Advanced therapies for recalcitrant warts are available but have higher risks for infection, scarring and side effects. These include topical imiquimod, topical compounded medications with fluorouracil, surgical excision, curettage and desiccation, intralesional candida injection and oral cimetidine. Discussion with the parents and patients at the initiation of therapy to delineate a course of action is necessary to establish reasonable expectations and ensure positive results.
- Jennifer Stern, MSN, FNP