Question of the Week # 442

442 ) A 14 month old toddler is brought to your out-patient clinic by her concerned mother regarding a rash that appeared recently in her ano-genital region. The rash has appeared 3 weeks ago and is persistent. Mother says she tried to use local Zinc Oxide  cream but it did not help. There is no history of fever. No vaginal discharge. She is otherwise healthy and reaching all her milestones appropriately. On examination, she is afebrile. There are several papules seen in the ano-genital area as shown below.

IMAGE 3 KIDS

Which of the following is the most appropriate next step?

A) Screen for Child Sexual Abuse

B) Local steroid application

C) Reassure that the rash will resolve in few months

D) Refrain the child from Day-care to prevent transmission

E) Local antibiotic application

28 Responses

  1. A

  2. A. Genital wart s/p sexual abuse. It appeared 3 weeks ago so likely not obtained in utero.

  3. B

  4. No bacterial infection, so no antibiotic needed and no need to refrain from day care center.
    No need for local steroid.
    Lesion appeared at 14 months after birth, so doesn’t seem like benign, no place for reassurance.
    Looks like sexual abuse (?? Condyloma or Mollusum)

  5. A

  6. C

  7. D. It can be DNA poxvirus, molluscum contagiousum. Probably kids’re going thru “potty training” and sharing the same toilet sits or smth like that.
    KOH prep would be mine advise to find out the reason of these pimples.

  8. The answer is “A”
    These are Molluscum Contagiosum lesions. ALWAYS and REGARDLESS to Tx we must screen for SEXUAL ABUSE However NOT necessarily transmited in this way. The rest of the above options are wrong and have nothing to do with this rash.

  9. d

  10. I am sure it is Molluscum.
    I would go for the Reassurance for the disappearance of the rash in 12 mo. If not use other Antiviral agents or scrapping it off or laser.

    I would not go for screening of the sexual abuse as I think the rash is also spread via contact of personal items, toys etc

  11. MC

  12. D. Molluscum. spread by contact with lesion

  13. D..molluscum contagiosum. spread by contact

  14. C. is molluscum contagiosum and spreads by touching a surface with the virus on it, it is not sexual abuse, it resolves in a couple of months.

  15. D. It can be DNA poxvirus, molluscum contagiousum.

  16. c.Molluscum contagiosum is a self limiting disease.

  17. C-molluscum contaginosum

  18. C molusco contagioso, si no remite en un par de meses se puede evaluar el curetaje o un queratolitico

  19. A. If majority of warts (molluscum contagiousum) are present in gential or anal areas of children, sexual abuse should be suspected. Otherwise, sexual abuse is highly unlikely and it is commonly in children.

  20. D. Hand foot and mouth disease.

  21. c

  22. MCV transmission usually takes place through direct skin-to-skin contact. Infections in childhood are often linked to swimming-pool attendance. Adults are infected usually through sexual contact. An intimate skin-to-skin contact is sufficient for transmission of the virus. In immunocompetent adults, the warts remain in the genital area and adjacent regions of the skin. In children and patients with immunocompromised conditions, however, various regions of the body are usually affected

  23. A): Molluscum contagiosum restricted to genital area. Although It is spread by direct skin contact and it can be contracted by infected hand, When molluscum is restricted to the genital area in a child, the possibility of sexual abuse must be considered.
    It will disappear spontaneously in few months in immunocompetent child.

  24. How can i know what is the correct ans. according to me its A. Is there anywhere, where i can see the answers.

  25. E-moluscum is not contraindication for school or day care…child only needs to avoid skin contact and get the lesions covered.will disappear spontaneously with in 2 years.

  26. C

  27. according to cdc Treatment for molluscum is usually recommended if lesions are in the genital area (on or near the penis, vulva, vagina, or anus). If lesions are found in this area it is a good idea to visit your healthcare provider as there is a possibility that you may have another disease spread by sexual contact.

    well this child is otherwise healthy and no vaginal discharge
    move case away from the abuse but still anogenital abuse needs to rule out at first hand

  28. MC:
    There are several ways it can spread.
    Direct skin-to-skin contact
    Indirect contact via shared towels or other items
    Auto-inoculation into another site by scratching or shaving more common in children.
    Sexual transmission in adults
    Transmission of mollusca appears to be more likely in wet conditions, such as when children bathe or swim together. The incubation period is usually about 2 weeks but can be as long as 6 months.
    C

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