Association Between Eczema and Molluscum Contagiosum

Eczema significantly increases susceptibility to molluscum contagiosum (MC) due to skin barrier defects, while topical corticosteroids and immunomodulators can exacerbate MC by suppressing local immune responses. Infants with eczema are at higher risk of molluscum. Below is a detailed analysis based on clinical evidence.

• Increased Risk: Individuals with eczema have a 3.58 times higher likelihood of developing MC due to compromised skin barriers, which facilitate viral entry^[1][2][3][4].
• Symptom Interaction: MC lesions often trigger eczema flares ("molluscum dermatitis") in surrounding skin, increasing itching and autoinoculation risk through scratching^[5][6][3].
• Disease Severity: Children with eczema typically experience more numerous and persistent MC lesions, often distributed across larger body areas^[6][3][4].

Impact of Topical Corticosteroids and Immunomodulators

• Worsening Infection:
  • Topical steroids suppress cell-mediated immunity and antiviral cytokine production (e.g., TNF-α, IFN-γ), creating a favorable environment for MC proliferation^[7][8][9].
  • Immunomodulators like methotrexate or fingolimod further increase susceptibility to disseminated MC by impairing systemic immune responses^[8].
• Relapse Risk:
  • Steroid use correlates with a higher MC relapse rate (odds ratio = 0.88 for potent steroids), as inflammation suppression hinders viral clearance^[10][11].
  • Cases show MC resolution after discontinuing topical steroids, even during immunomodulator therapy (e.g., dupilumab)^[9].

Clinical Management Guidance

• Avoiding Harm:
  • Topical steroids should be used minimally on MC-affected skin; prioritize emollients for associated eczema^[7][5][12]
  • Never apply steroids directly to MC lesions, as this may mask infection and promote spread^[7][5].
• Alternative Treatments:
  • There are numerous options for molluscum treatment^[13]. Many rely on immune response mediated mechanisms. 
  • Immune Support: Inflamed MC lesions (indicating immune activity) often precede resolution; avoid suppressing this response^[5][6].

Key Recommendations

• Prevention: Address eczema flares promptly with barrier repair (e.g., emollients) to reduce MC risk^[3][4]. Coconut oil is an effective barrier.
• Monitoring: Discontinue topical steroids if MC persists despite eczema improvement^[9][12].
• First-Line MC Treatment: Natural resolution is preferred; if intervention is needed, use non-immunosuppressive options^[1][14][12].
• Covering large molluscum with a hydocolloid patch is a first line approach to limit spread.^[3]

Topical corticosteroids and immunomodulators require cautious use in eczema patients with MC due to their dual role in managing dermatitis while potentially exacerbating viral infections. Individualized treatment should balance eczema control and MC containment.

1. https://www.webmd.com/skin-problems-and-treatments/eczema/eczema-and-molluscum-contagiosum
2. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0103419
3. https://www.mollenol.com/molluscum-home-treatment/
4. https://dermnetnz.org/topics/molluscum-contagiosum
5. https://pubmed.ncbi.nlm.nih.gov/22412023/
6. https://jamanetwork.com/journals/jamadermatology/fullarticle/1351941
7. https://dermnetnz.org/topics/topical-steroid
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC7369509/
9. https://pmc.ncbi.nlm.nih.gov/articles/PMC11415223/
10. https://pubmed.ncbi.nlm.nih.gov/21691050/
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC4684036/
12. https://iusti.org/wp-content/uploads/2020/01/MolluscumContagiosumGuideline.pdf
13. https://opendermatologyjournal.com/VOLUME/18/ELOCATOR/e18743722340545/PDF/
14. https://evidence.nihr.ac.uk/alert/molluscum-contagiosum-is-best-left-to-clear-by-itself/
15. https://www.mollenol.com/q-a/using-coconut-oil-for-eczema/