What doctors wish patients knew about “water warts”

Molluscum contagiosum, more commonly known as “water warts,” is a highly contagious skin infection caused by a poxvirus. While the condition is generally harmless, its persistent and sometimes unsightly lesions can cause anxiety and confusion for families. Becoming familiar with the signs, symptoms and best practices for preventing the spread of this surprisingly common viral skin infection is key.

The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.

In this installment, Desiree Evans, MD, MPH, a pediatrician at Texas Children’s Pediatrics in Houston, discusses what patients need to know about water warts.

Texas Children’s Pediatrics is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Molluscum contagiosum can happen “anytime of the year. Sometimes we do feel like we see it a little bit more in the warmer climates because kids are outside, playing and touching everything,” said Dr. Evans. “But it can also happen in the winter because we’re also locked inside and so the family and kids are touching the same things and in close spaces.

Desiree Evans, MD, MPH

“Plus, sometimes they may be sick and so they’re cuddled up with their parents and things like that,” she added. “So, molluscum does not have a season, does not have a time frame. We see it all throughout the year.”

“Whether kids are in school, camps or together anywhere, there’s always that risk of them passing and spreading molluscum,” Dr. Evans said. 

“The medical term is molluscum contagiosum and it comes from the poxvirus, so it’s very similar to some of the other viruses such as varicella. But it’s not treated the same,” Dr. Evans said. “So, molluscum is spread typically from person-to-person contact with direct skin contact or contact with any type of materials that may have the virus sitting on it such as towels, razors or cups.”

“It’s very easily spread, especially among kids who touch everything and each other all the time,” she added. 

Water warts “are raised, usually dome-shaped, flesh-colored lesions. They almost always have a pearly appearance. They also can have a little bit of ulceration,” said Dr. Evans, noting that “sometimes they have just a little bit of the central clearing to them as well. They're very distinct in appearance.”

“When you're dealing with eczema, it tends to be more flat. Sometimes it's a darker color, sometimes it's a lighter color and seems really rough whereas molluscum contagiosum is very distinct, little bumps,” she said. “Sometimes they are in clusters or groups because the child is scratching, but it's a dome-shaped flesh-colored bump and it's a very distinct appearance from even a mosquito bite.”

Water warts are different than “summer finger bumps,” or dyshidrotic eczema, which is a condition causing small, fluid-like blisters that form on the fingers and palms and is often caused by an allergic reaction, irritation from moisture, stress and warm weather. Summer finger bumps are not contagious. Meanwhile, water warts develop from a virus as well, can last several months, and are highly contagious.  

“The interesting thing about molluscum is you can get it almost anywhere,” said Dr. Evans, “except for the palms of your hands and the soles of the feet. 

“There's something about the palms of hands and soles of feet that just cannot necessarily hold the virus, but literally anywhere else on your body you can get molluscum,” she added.

“Interestingly enough, if you're immunocompetent—meaning you have a normal immune system—you can get a lot of the spots,” said Dr. Evans. “We typically see lots of lesions in younger kids because what they tend to do is pick or scratch them.”

“The more you pick, the more you scratch, the more you can inoculate yourself and spread the lesions,” she said. “And so sometimes you'll see a linear lesion and that's because the kid has just been scratching and picking and scratching and picking, and then it just spreads.” 

“You’ll sometimes also see it linear or a group of them are clustered and it’s interesting because you really see them everywhere that kids touch,” Dr. Evans said. “They’ll scratch their hands, then they’ll touch their face, and you’ll see it on the cheeks, or they will rub their nose or scratch behind their legs and knees.”

“You do not have to test for it. You don't have to scrape it. You don't have to do anything because if you try to scrape it, you might spread it even more or spread it to yourself,” Dr. Evans said. “So, you usually don't have to do any of that. 

“It's so distinct that ... when I see it on kids, I can tell you automatically that this is molluscum contagiosum,” she added. “It's a quick, easy diagnosis and it's not really going to hurt them.”

With water warts, “usually it is cosmetic and typically that’s why we will treat them. I’ve had parents come in multiple times because they don’t like how it looks and want to do something about it,” Dr. Evans said, noting “there are some treatments that are out in the market.”

For example, “you can freeze it and remove the papules,” but don’t try to remove them on your own, she said. There are also topical creams or ointments that can help speed up recovery time and reduce symptoms as well as medications, such as cimetidine, that are commonly used to treat infections in kids. 

“Sometimes you can cut or scrape it off. And studies have shown that when you do that, it does heal faster. But sometimes when you do that, you may leave scarring,” Dr. Evans said. “It may also hurt a lot more and just may irritate it even more even if it is effective.”

“If you have it and if you leave it alone, it will go away on its own, but you have to be prepared because it may stay on sometimes up to a year,” Dr. Evans said. “It can last for a very long time, but it spreads and it’s contagious.”

“Kids can go to day care, school, camps everything, but we encourage parents to cover it up if it is in places that are open,” she said. “So, if it’s on their arms or legs and they’re wearing shorts or a T-shirt, maybe just put a little Band-Aid or something over it so that way your child is not scratching it and so another kid doesn’t touch it.”

“If you just cover up the water warts and leave them alone, in a couple months to a year it’ll be gone,” she said.

"I’m a little bit more leery when I start to see molluscum contagiosum around the eyes,” said Dr. Evans, noting that if that happens “I will sometimes send them to the dermatologist or an ophthalmologist for further assessment. 

“Sometimes they may freeze them off, but when you’re trying to freeze or do cryotherapy on a child, it can be painful,” she added. “So, even though it will heal quicker than it would if you do nothing, sometimes the healing process makes it look even worse for a little while.”

"You have this virus—the poxvirus—unlike when you have chickenpox, and typically you don’t get it again, you can get molluscum contagiosum again,” Dr. Evans said, emphasizing that “you can get it repeatedly.”

"So, that’s why it’s still important if you’ve had it once, you know how long it takes to go away, you’re making sure you’re not sharing any of your personal items, not sharing your towels, making sure you're washing your hands,” she said. 

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“Molluscum contagiosum is more common in children than adults, but parents actually can get it too,” said Dr. Evans. “I always tell parents, if you do touch it, make sure you’re washing your hands; make sure you bathe your child well.”

“Parents can get it and we just tell them to make sure to wash your hands and cover the lesions if you know you’re going to be out and about,” she said.

For children with water warts, it is important to not share items, “especially now as we’re getting into the summertime and people are going to go to the beach or the pool,” Dr. Evans said. That means, “don’t share towels and don’t share other close products.”

“For example, for teen girls and boys, don’t share razors and try not to share other clothing or products that may touch the skin, especially in locations where you can have molluscum, which is pretty much anywhere,” she said.

"It’s a good idea to see your pediatrician regardless because you may think it is water warts, but it may also be something different,” Dr. Evans said. “Very small ones sometimes can look like plantar warts as they’re growing or sometimes as they start. 

“So, parents will say it’s just a plantar wart and they’ll try to apply some of that medication only to find out it is not,” she added. “That’s why it’s always a good idea to see your pediatrician so they can confirm the diagnosis and walk through with you the management plan.”

“Also, pediatricians can talk with you about watching the rest of the family for prevention such as not sharing the towels and things like that,” Dr. Evans said. “We’re always here to educate.”