Pearl warts: symptoms, causes & treatment

Pearl warts are tiny, shimmering balls on the skin caused by a viral infection. The official name is molluscum contagiosum, which refers to the infectious nature of the condition. The virus belongs to the poxvirus family and causes a local infection of the epidermis without penetrating further into the body.

The condition is completely harmless and does not affect your overall health. The virus remains confined to the outer layer of the skin and causes small growths filled with a white, cheesy substance. This substance contains virus particles that can spread the infection to other parts of your body or to other people.

What distinguishes pearl warts from other skin conditions is their characteristic appearance. The small spheres usually have a shiny surface with a central dimple, which gives them the appearance of a miniature volcano. They are skin-coloured to light pink or white and feel firm when touched.

The disorder mainly affects children between the ages of 2 and 12, although babies and teenagers can also get it. In adults, it is rarer and usually indicates underlying immune system problems. Children with sensitive skin, such as atopic eczema, have a higher risk of developing pearl warts.

Pearl warts are caused by infection with the molluscum contagiosum virus. Transmission occurs through direct contact with an infected person or indirectly via contaminated objects such as towels, washcloths or toys. The virus can also spread via water, hence the name water warts. Swimming pools, hot tubs and communal baths are therefore places where contamination can easily occur.

After infection, the virus enters the epidermis through minor damage in the skin, sometimes so small that you can't see them. In the skin cells, the virus multiplies, leading to a thickening of the skin and the formation of the characteristic spheres. This process usually takes two to eight weeks, which means that there can be quite a while between the infection and when you see the first pearl warts.

The mollusca grow slowly to their final size of a few millimetres. They can remain solitary but more often occur in the same region. Scratching the lesions spreads the virus to neighboring skin areas, causing new mollusca. This explains why they often appear in groups or lines, following the pattern of crab lines.

The virus remains confined to the epidermis and does not penetrate deeper into your body. It also does not spread through the bloodstream to internal organs, making the condition harmless. Your immune system gradually develops defenses against the virus, which explains why the infection eventually goes away on its own.

Bee children with atopic eczema molluscum contagiosum is more common because their skin barrier is less intact. The dry, broken skin in eczema makes it easier for the virus to penetrate. The itchy eczema can also cause children to scratch more, which helps spread the virus.

In adults, molluscum contagiosum sometimes indicates a weakened immune system. In people with HIV, in organ transplant patients who take immunosuppressive drugs, or in people with other conditions that reduce immunity, pearl warts may be more extensive and last longer.

Recognizing pearl warts is usually not difficult thanks to their characteristic appearance. The mollusca are small, somewhat glittering balls that look smooth and shiny. They are a few millimetres in diameter, usually between 2 and 5 millimetres, although they can sometimes become larger.

The most characteristic aspect is the central dimple in the middle of each ball. This gives them the appearance of a mini volcano. When you press gently, a white, cheesy substance sometimes comes out of this hole full of virus particles.

The color ranges from skin color to light pink or pearl white. They have a shiny surface that distinguishes them from common warts. When touched, they feel firm and smooth. They are not usually painful unless they become inflamed due to scratching.

Pearl warts usually occur in small groups. They can line up according to the pattern of scratch lines where you spread the virus. The number can range from a few to dozens. Generally, they do not cause itching or pain. If a molluscum becomes irritated by friction, it can become red and sore.

In principle, pearl warts can occur anywhere on your body, but they do have preferred locations. The hull is a common location. Chest, abdomen, and back are often riddled with mollusca. These areas come into regular contact with contaminated surfaces.

The arms and legs are also frequently affected. The outside of the arms and thighs are favorite spots. These areas often come into contact with surfaces such as playground equipment and pool seams. The armpits and groin are sensitive areas where pearl warts like to form due to heat and humidity.

The face is less commonly affected in children, but it can occur. The cheeks, around the eyes, and the chin may show mollusca. Take extra care in case of injuries near the eyes. The genital area may be affected, especially in teenagers and adults where infection has occurred through sexual contact.

It is important that pearl warts usually spare the palms and soles. This distinguishes them from common warts. The scalp hair and nails are also not affected.

The decision to treat pearl warts depends on several factors. For many children, waiting is a valid option because the infection usually heals by itself. On the other hand, active treatment can have benefits.

Spontaneous healing is the natural course. Your immune system gradually develops defenses against the virus, after which the mollusca disappear on their own. However, this can take a long time, sometimes six months to two years. For some parents and children, this long wait is difficult to accept.

Active treatment of the first mollusca can stop the spread and accelerate the healing process. The most common method is removal with a curette, a small spoon with a sharp edge that allows the doctor to remove the ball from the skin. This procedure is effective but can be painful.

To reduce pain, a local anesthetic cream is applied thirty minutes before treatment. It is important to cover this cream with plastic wrap. After removal, a small wound remains. The wound heals within a few days. If there are very many mollusca, the treatment will be spread over two or three sessions.

Another method is freezing with liquid nitrogen. The extreme cold destroys the infected skin cells. This method can be painful and sometimes requires several sessions. It is especially suitable for older children.

For young children who are anxious or whose treatment is difficult, your doctor may recommend waiting for spontaneous healing. This is a completely acceptable choice because the condition is harmless.

There is no scientific evidence that topical creams or ointments are effective against pearl warts. Various products are advertised on the internet, but they have no proven effect. The virus is deep enough in the skin that superficial treatments don't reach it.

Drug therapy with tablets is also not effective. The virus stays locally in the skin and does not spread through the bloodstream. Aggressive scratching or trying to remove it yourself usually worsens the problem. You risk infection and spread the virus to other parts of your body.

Complete isolation of the child is unnecessary and even undesirable. Although pearl warts are contagious, it is unrealistic to keep children completely at home. However, it is wise to take precautions such as not taking a bath together.

Exaggerated hygiene measures such as constant disinfection are of limited use. Normal hygiene is sufficient. The virus mainly spreads through direct contact.

Are pearl warts contagious?

Yes, pearl warts are contagious. The virus spreads through direct contact with the mollusca or indirectly through contaminated objects such as towels and washcloths. Water can play a role in spreading because the virus can remain on surfaces in humid environments, which can increase the chance of contact spread. Yet direct skin-to-skin contact is the main route of infection in molluscum contagiosum, and water contact alone is not usually the most common route of transmission.

How long do pearl warts last?

Pearl warts usually heal on their own within six months to two years. The duration varies greatly from child to child. For some, they disappear after a few months; for others, it takes longer. Treatment can shorten the process, especially if you remove the first mollusca early. Treating underlying eczema or dry skin can also help pearl warts heal faster. Throughout the healing phase, new mollusca may continue to appear before they all disappear.

Does my child have to stay home from school or swim?

No, children with pearl warts don't have to stay home from school. They can just go to school and are also allowed to swim. However, it is wise to cover the mollusca with a waterproof plaster while swimming to limit the spread. Teach your child not to scratch the balls and to use their own towels.

Can pearl warts come back after they disappear?

Yes, it is possible to become infected again after the initial infection has healed. You do build up some immunity against the virus, but this protection is not complete. A new infection can occur, especially if you come into contact with the virus again. However, re-infections are less frequent than the first infection.

When should I see a doctor?

See your doctor when you discover the first pearl warts to confirm the diagnosis. Medical advice is also important in case of rapid spread, many molluscs, lesions that become inflamed or in case of doubt about the diagnosis. For adults with pearl warts, it is always wise to consult your doctor as this may indicate a weakened immune system.

Will there be scars left behind?

No, pearl warts don't usually leave scars. If they disappear on their own or are professionally removed, the skin heals without permanent marks. Only when infected or scratched aggressively can small scars occur. Therefore, do not let your child scratch the mollusca and let a professional remove it.

1. Health and Science: Pearl Warts (molluscum contagiosum)
   
2. Ebpnet: Evidence-based guidelines for the general practitioner
   
3. Child and Family: Water or Pearl Warts
   

‍