What are the symptoms of molluscum contagiosum. How is molluscum contagiosum diagnosed. What are the available treatment options for molluscum contagiosum. Can molluscum contagiosum be prevented. How long does molluscum contagiosum last. Is molluscum contagiosum dangerous. Who is most at risk for molluscum contagiosum.

Understanding Molluscum Contagiosum: A Comprehensive Overview

Molluscum contagiosum is a viral skin infection that causes small, painless bumps on the skin. This condition is caused by a poxvirus and is highly contagious, spreading through direct skin-to-skin contact or contact with contaminated objects. While it can affect people of all ages, it is most common in children and individuals with weakened immune systems.

The characteristic feature of molluscum contagiosum is the appearance of small, flesh-colored or pink bumps on the skin. These bumps, known as molluscum, typically have a dimple or indentation in the center and can appear anywhere on the body. In children, they are often found on the face, arms, legs, and torso, while in adults, they may also appear in the genital area.

Key Facts About Molluscum Contagiosum

• Caused by the molluscum contagiosum virus (MCV)
• Highly contagious through direct contact
• Can affect people of all ages, but most common in children
• Generally harmless and self-limiting
• May take 6-12 months or longer to resolve without treatment

Identifying Molluscum Contagiosum: Signs and Symptoms

Recognizing the signs and symptoms of molluscum contagiosum is crucial for early diagnosis and management. The primary symptom is the appearance of small, round, and smooth bumps on the skin. These bumps typically have the following characteristics:

• Size ranging from 2 to 5 millimeters in diameter
• Flesh-colored, pink, or white appearance
• Firm and dome-shaped
• Central indentation or dimple
• May appear shiny or pearly
• Can occur in clusters or spread out

In some cases, the bumps may become red, swollen, or itchy, especially if scratched or irritated. It’s important to note that while molluscum contagiosum is generally painless, some individuals may experience discomfort or itching in the affected areas.

Distribution of Molluscum Lesions

The location of molluscum lesions can vary depending on the age of the affected individual and the mode of transmission:

• In children: Commonly found on the face, trunk, arms, and legs
• In adults: May appear on the genitals, inner thighs, and lower abdomen (if transmitted sexually)
• In individuals with weakened immune systems: Can be more widespread and difficult to treat

Diagnosing Molluscum Contagiosum: What to Expect

Accurate diagnosis of molluscum contagiosum is essential for proper treatment and management. Healthcare providers typically diagnose this condition through a combination of visual examination and, in some cases, additional tests.

Visual Examination

In most cases, a dermatologist or healthcare provider can diagnose molluscum contagiosum by visually inspecting the affected areas. The characteristic appearance of the bumps, including their size, shape, and central indentation, is often sufficient for a diagnosis.

Skin Biopsy

In rare cases where the diagnosis is uncertain, a skin biopsy may be performed. This involves removing a small sample of the affected skin for microscopic examination. Under a microscope, molluscum contagiosum lesions show distinctive features that confirm the diagnosis.

Differential Diagnosis

Healthcare providers may need to rule out other skin conditions that can resemble molluscum contagiosum, such as:

• Warts
• Chickenpox
• Skin tags
• Folliculitis
• Certain types of skin cancer

Treatment Options for Molluscum Contagiosum: From Natural Healing to Medical Interventions

While molluscum contagiosum often resolves on its own without treatment, some individuals may opt for interventions to speed up the healing process or prevent spread. The choice of treatment depends on factors such as the extent of the infection, the patient’s age and overall health, and personal preferences.

Natural Healing (Watchful Waiting)

In many cases, particularly in children with healthy immune systems, healthcare providers may recommend allowing the infection to clear on its own. This approach, known as watchful waiting, involves monitoring the lesions without active treatment. The immune system typically clears the virus within 6-12 months, although it may take longer in some cases.

Topical Treatments

Several topical medications can be used to treat molluscum contagiosum:

• Imiquimod: An immune response modifier that stimulates the body’s immune system to fight the virus
• Podophyllotoxin: A medication that destroys viral-infected cells
• Potassium hydroxide: A solution that can help dissolve the lesions
• Tretinoin: A retinoid that may help speed up the natural healing process

Physical Removal Methods

In some cases, healthcare providers may recommend physically removing the molluscum lesions. These methods include:

• Cryotherapy: Freezing the lesions with liquid nitrogen
• Curettage: Scraping off the bumps with a small, spoon-shaped tool
• Laser therapy: Using laser energy to destroy the lesions
• Electrocautery: Burning off the bumps with an electric current

It’s important to note that these procedures should only be performed by trained healthcare professionals to minimize the risk of scarring or infection.

Preventing the Spread of Molluscum Contagiosum: Essential Strategies

While molluscum contagiosum is highly contagious, there are several measures that can help prevent its spread and reduce the risk of infection:

Personal Hygiene

• Wash hands frequently with soap and water, especially after touching molluscum lesions
• Avoid scratching or picking at the bumps to prevent autoinoculation (spreading the virus to other parts of the body)
• Keep affected areas clean and covered with clothing or waterproof bandages

Limiting Physical Contact

• Avoid direct skin-to-skin contact with individuals who have visible molluscum lesions
• Refrain from sharing personal items such as towels, clothing, or bathing accessories
• Use barrier protection during sexual activity if lesions are present in the genital area

Environmental Precautions

• Clean and disinfect shared surfaces and objects, particularly in communal areas like gyms or swimming pools
• Avoid sharing sports equipment or other items that come into direct contact with the skin
• Wash bedding, towels, and clothing used by infected individuals in hot water and detergent

Molluscum Contagiosum in Special Populations: Children, Athletes, and Immunocompromised Individuals

While molluscum contagiosum can affect anyone, certain groups may be more susceptible to infection or experience more severe cases. Understanding the unique considerations for these populations is crucial for effective management and prevention.

Children

Molluscum contagiosum is particularly common in children, especially those between the ages of 1 and 10. This higher prevalence is due to several factors:

• Frequent close contact with other children during play
• Underdeveloped immune systems
• Tendency to share toys and personal items
• Difficulty in maintaining consistent hygiene practices

For children with molluscum contagiosum, healthcare providers often recommend watchful waiting as the preferred approach, as the infection typically resolves on its own without scarring. Parents and caregivers should focus on preventing spread to other children and siblings.

Athletes

Athletes, particularly those involved in contact sports or activities with shared equipment, may be at higher risk for molluscum contagiosum. Specific considerations for athletes include:

• Increased skin-to-skin contact during sports activities
• Shared use of equipment, mats, or towels
• Prolonged exposure to warm, moist environments (e.g., locker rooms, swimming pools)

Athletes with molluscum contagiosum should take extra precautions to prevent spread, such as covering lesions during activities and avoiding sharing personal items. In some cases, treatment may be recommended to minimize the risk of transmission to teammates.

Immunocompromised Individuals

People with weakened immune systems, such as those with HIV/AIDS or undergoing chemotherapy, may experience more severe and persistent cases of molluscum contagiosum. For these individuals:

• Lesions may be larger, more numerous, and more widespread
• The infection may persist for longer periods
• Treatment may be more challenging and require a combination of approaches

Healthcare providers may recommend more aggressive treatment strategies for immunocompromised patients to manage symptoms and prevent complications.

Living with Molluscum Contagiosum: Coping Strategies and Quality of Life

While molluscum contagiosum is generally a benign condition, it can have psychological and social impacts on those affected. Understanding how to cope with the infection and maintain a good quality of life is essential for overall well-being.

Emotional Impact

Some individuals, particularly children and adolescents, may experience emotional distress due to the appearance of molluscum lesions. This can lead to:

• Feelings of embarrassment or self-consciousness
• Social isolation or avoidance of activities
• Anxiety about spreading the infection to others

Parents and caregivers should provide emotional support and reassurance, emphasizing that the condition is temporary and not a reflection of personal hygiene or health.

Managing Symptoms

While molluscum contagiosum is often painless, some individuals may experience itching or discomfort. To manage these symptoms:

• Apply cool compresses to soothe itchy or irritated areas
• Use over-the-counter antihistamines to reduce itching
• Keep the skin moisturized to prevent dryness and further irritation
• Avoid scratching or picking at lesions to prevent secondary bacterial infections

Maintaining Normal Activities

In most cases, individuals with molluscum contagiosum can continue their regular activities with some modifications:

• Cover visible lesions with clothing or waterproof bandages during sports or swimming
• Inform school teachers or caregivers about the condition to ensure appropriate precautions
• Continue social interactions while taking steps to prevent transmission

By following these strategies, individuals can maintain a good quality of life while managing molluscum contagiosum and minimizing its impact on daily activities.

Myths and Misconceptions About Molluscum Contagiosum: Separating Fact from Fiction

There are several common myths and misconceptions surrounding molluscum contagiosum that can lead to unnecessary worry or inappropriate management. Let’s address some of these misconceptions and provide accurate information:

Myth 1: Molluscum contagiosum only affects children

Fact: While molluscum contagiosum is more common in children, it can affect people of all ages. Adults can contract the virus, particularly through sexual contact or in settings with close skin-to-skin contact.

Myth 2: Molluscum contagiosum is caused by poor hygiene

Fact: The infection is caused by a virus and is not related to personal cleanliness. Good hygiene practices can help prevent spread, but even individuals with excellent hygiene can contract molluscum contagiosum through contact with an infected person or contaminated objects.

Myth 3: Molluscum contagiosum always requires treatment

Fact: In many cases, especially in individuals with healthy immune systems, molluscum contagiosum will resolve on its own without treatment. While treatment options are available, they are not always necessary.

Myth 4: Once you’ve had molluscum contagiosum, you can’t get it again

Fact: While having molluscum contagiosum may provide some immunity, it is possible to be reinfected, especially if exposed to a different strain of the virus.

Myth 5: Molluscum contagiosum is dangerous and can lead to serious health problems

Fact: For most people, molluscum contagiosum is a benign condition that does not cause serious health issues. However, in individuals with weakened immune systems, it can be more persistent and widespread.

Myth 6: You can’t go swimming if you have molluscum contagiosum

Fact: While it’s important to take precautions, individuals with molluscum contagiosum can generally continue swimming. Covering visible lesions with waterproof bandages and practicing good hygiene can help prevent spread in aquatic environments.

By dispelling these myths and providing accurate information, we can promote better understanding and management of molluscum contagiosum, reducing stigma and unnecessary anxiety associated with the condition.

Molluscum contagiosum: Diagnosis and treatment

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Molluscum Contagiosum – StatPearls – NCBI Bookshelf

Continuing Education Activity

Molluscum contagiosum, also called water warts, is a benign condition of the skin. The skin lesions of molluscum contagiosum are called mollusca. The typical lesion appears dome-shaped, round, and pinkish-purple in color. This activity reviews the cause and presentation of molluscum contagiosum and highlights the role of the interprofessional team in its management.

Objectives:

• Explain the cause of molluscum contagiosum.

• Describe the appearance of molluscum contagiosum.

• Outline the treatment of molluscum contagiosum.

• Review the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by molluscum contagiosum.

Access free multiple choice questions on this topic.

Introduction

Molluscum contagiosum, also called water warts, is a benign condition of the skin. The skin lesions of molluscum contagiosum are called mollusca. The typical lesion appears dome-shaped, round, and pinkish-purple in color.[1][2][3]

Etiology

A double-stranded DNA poxvirus called molluscum contagiosum virus (MCV) causes molluscum contagiosum. Four subtypes of the molluscum contagiosum virus are known, and the are MCV-1 (98% of cases) is mostly seen in children, while MCV-2 is mainly responsible for skin lesions in people living with HIV. MCV-3 and MCV-4 are present in Asia and Australia. Currently, it is not possible to have cultures of molluscum contagiosum virus.

Molluscum contagiosum lesions are transmitted by direct skin-to-skin (including sexual) or indirect (towels, underclothes, toys, razor, tattoo supplies) contact. Molluscum contagiosum may also disseminate by autoinoculation to normal skin after mollusca scraping by the patients. Transmission from sharing swimming pools and other wet environments is possible but not fully proven. In utero and prepartum transmissions are occasionally reported, resulting in congenital molluscum contagiosum or skin lesions developing during the early months of life.[4][5]

Epidemiology

Molluscum contagiosum is a common medical concern. In 2010, there were about 122 million cases. It occurs worldwide but seems to be more frequent in warm, humid regions. Molluscum contagiosum is diagnosed mainly in children aged two to five years, but also in sexually active teenagers and adults, and immunocompromised persons. Atopic dermatitis may increase the risk of developing molluscum contagiosum since it alters the skin barrier and immunity function. In people living with HIV (human immunodeficiency virus), the clinical prevalence of molluscum contagiosum may reach up to 18%. No gender predominance is noted.[6]

Pathophysiology

The incubation period ranges from two weeks to six months. Molluscum contagiosum virus infects only keratinocytes, and skin lesions are limited to the epidermis and do not have systemic dissemination. Molluscum contagiosum virus produces proteins inhibiting human antiviral immunity, thus preventing the development of innate immunity response, and contributing to the persistence of skin lesions.[7]

Histopathology

Molluscum contagiosum lesions have classic features under a microscope. The cup-shaped indentation of the epidermis into the dermis is usually seen. The proliferated rete ridges descend downwards and encircle the dermis. The epidermis is usually thickened and there is the presence of Henderson-Paterson bodies seen within the epidermis. It is these bodies that enclose the virus particles. 

History and Physical

Molluscum contagiosum causes mainly cosmetic concerns. Mollusca is usually asymptomatic but may be painful or itchy. In atopic persons, eczema lesions may develop around mollusca weeks after their occurrence. An inflammatory reaction, secondary to scratching or occurring when mollusca start to resolve, is frequent and should be distinguished from secondary bacterial infection. When scratched or removed, molluscum contagiosum can lead to bleeding under every single element.

Evaluation

The diagnosis of molluscum contagiosum is based on clinical examination. Lesions are firm, white to flesh-colored, dome-shaped, pearly papules, having a central umbilication from which one can express a cheesy material. Mollusca is usually one millimeter to one centimeter in diameter.[8][9]

In children, mollusca are located on the face, trunk, limbs, and axillary areas. Palms and soles are not involved. In sexually transmitted forms, lesions are mainly observed in the anogenital area, abdomen, and inner thighs. There are rarely more than 20 to 30 elements over the skin and are usually grouped together. However, molluscum contagiosum may be extensive, mostly in immunocompromised persons.

The differential diagnosis of molluscum contagiosum in children includes syringoma, closed comedones (whiteheads), and warts (including anogenital ones).

In immunocompromised persons, molluscum contagiosum lesions may be atypical, have a greater size, and/or mimic malignancies, such as basal cell carcinoma or keratoacanthoma (for single lesions), or other infectious diseases, such as cryptococcosis and histoplasmosis (for extensive lesions).

In the case of a diagnosis difficulty, dermoscopy, reflectance confocal microscopy, and histopathology may be useful.

Dermoscopy of a molluscum shows a central white to a yellow amorphous area, with peripheral linear or branched vessels.

Reflectance confocal microscopy also shows a well-defined central area, which contains septa separating hypo-refractive roundish lobules. Histopathologically, these lobules consist of enlarged keratinocytes having an abundant cytoplasm containing viral inclusions (also called Henderson Paterson bodies) and a peripheral nucleus. The nearby epidermis shows marked acanthosis.

Treatment / Management

People frequently seek treatment for cosmetic reasons, to avoid social stigma, or because they have concerns of transmission to other individuals. The treatment depends on the patient’s (or their parent’s) preferences. Because the condition is usually self-limiting, awaiting spontaneous resolution should be considered. However, the patients should be aware that the resolution of molluscum contagiosum may take several months. Even though many treatments had been proposed for molluscum contagiosum, none has proven its effectiveness. Current treatment options include physical removal of mollusca, topical medications, and systemic treatment.[10][11][12]

Physical removal is based mainly on cryotherapy with liquid nitrogen or curettage. Techniques might be associated. Laser treatment (carbon dioxide or pulsed dye laser) may also be used but not as first-line therapy. Physical removal is usually painful and may require local anesthesia. Postoperative scarring is possible. Topical trichloroacetic acid can be used to treat mollusca with minimal scarring.

Doctors recommend many topical treatments for molluscum contagiosum. Podophyllotoxin (contraindicated in pregnant women), potassium hydroxide, salicylic acid (associated or not with povidone-iodine), benzoyl peroxide, and tretinoin are used as home treatments and must be applied to each lesion. They are used with the aim to induce an inflammatory reaction, thus accelerating recovery. In a recent analysis, imiquimod, which is used as a modulator of the immune system, and cantharidin, a blistering topical applied by the physician, has not been found to be more effective than other vehicles.

The use of oral cimetidine has been described as a safe alternative to physical removal in children who fear pain (except for facial involvement). However, a recent meta-analysis did not show any difference with cimetidine. Cidofovir, a DNA polymerase inhibitor, has been used successfully in immunosuppressed persons, but it may induce nephrotoxicity and neutropenia when used intravenously. In people living with HIV/AIDS, molluscum contagiosum is best managed with highly active antiretroviral therapy (HAART).

Differential Diagnosis

• Keratoacanthoma

• Lichen planus

• Epidermal cyst

• Pyoderma

• Verruca vulgaris

• Folliculitis

• Cutaneous fungal disorders like histoplasmosis and sporotrichosis

• Basal cell cancer

• Condyloma acuminatum

• Varicella-zoster

Complications

• Inflammation or infection (cellulitis)

• Irritation

• Conjunctivitis if the lesions are on the eyelids

• Abscess

Pearls and Other Issues

Most molluscum contagiosum lesions in non-compromised persons resolve spontaneously within an average duration of six to 12 months. However, the course of molluscum contagiosum may take as long as four years. During that period, some mollusca may heal without any intervention, while others occur. Unlike other viruses, the molluscum contagiosum virus no longer exists within the body after healing. However, it remains possible to develop molluscum contagiosum again after repeated contact with an infected person or a contaminated fomite. Scarring is unusual in molluscum contagiosum unless lesions are scratched or scrapped. In immunocompromised persons, longer duration and resistance to therapy are common. Malignant transformation has never been reported.

Enhancing Healthcare Team Outcomes

The management of molluscum contagiosum is best done with an interprofessional team that also includes the primary care provider and nurse practitioner. The important thing is that these lesions spontaneously resolve in most patients; thus patient education is vital. Patients should be told that there is a small risk of autoinoculation or infection of others. For those who decide to be treated, more than one session may be required. This information is important for the patient as it prevents them from seeking unnecessary therapies and making unreasonable demands. Parents should not keep children out of school, but the infected skin area can be covered with a garment. Since this virus can be sexually transmitted, the patient should be encouraged to practice safe sex and use barrier methods for protection. [13][14][15](Level V)

Outcomes

In the majority of patients, molluscum contagiosum resolves without any residual scars. The disorder is benign and spontaneous resolution is the usual outcome, but it may take 12-24 months. In some individuals, the lesions may persist for 3-5 years and may be disfiguring. Recurrences occur in one-third of patients. In patients with HIV or those who are immunocompromised, the lesions are generalized and occur when the CD4 counts are low. In these patients, spontaneous resolution of the lesions is rare. [16][17][18] [Level 5]

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Figure

Molluscum Contagiosum. Contributed by DermNetNZ

Figure

Figure 2 Pseudokoebnerization: (A) Of flat warts in the threading area of a young lady; and (B) Ofmolluscum contagiosum (MC) lesions in an immunosuppressed patient. Appreciate the florid lesions of genital MC and evidence of linear clusters at multiple (more…)

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Nyati A, Gupta S, Jain SK, Yadav D, Patidar BL, Sharma M. A retrospective study of the pattern of sexually transmitted infections from a tertiary care hospital of Rajasthan. Indian J Sex Transm Dis AIDS. 2017 Jul-Dec;38(2):147-151. [PMC free article: PMC6085942] [PubMed: 30148268]

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Peterson AR, Nash E, Anderson BJ. Infectious Disease in Contact Sports. Sports Health. 2019 Jan/Feb;11(1):47-58. [PMC free article: PMC6299350] [PubMed: 30106670]

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Rosner M, Zloto O. Periocular molluscum contagiosum: six different clinical presentations. Acta Ophthalmol. 2018 Aug;96(5):e600-e605. [PubMed: 29855150]

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Leung AKC, Barankin B, Hon KLE. Molluscum Contagiosum: An Update. Recent Pat Inflamm Allergy Drug Discov. 2017;11(1):22-31. [PubMed: 28521677]

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Ruby KN, Perry AE, Linos K. Expanding the Morphologic Heterogeneity of Stromal Changes in Molluscum Contagiosum Infection. Am J Dermatopathol. 2018 Dec;40(12):941-943. [PubMed: 29329128]

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Rayala BZ, Morrell DS. Common Skin Conditions in Children: Skin Infections. FP Essent. 2017 Feb;453:26-32. [PubMed: 28196318]

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Lacarrubba F, Verzì AE, Dinotta F, Scavo S, Micali G. Dermatoscopy in inflammatory and infectious skin disorders. G Ital Dermatol Venereol. 2015 Oct;150(5):521-31. [PubMed: 26333553]

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Rush J, Dinulos JG. Childhood skin and soft tissue infections: new discoveries and guidelines regarding the management of bacterial soft tissue infections, molluscum contagiosum, and warts. Curr Opin Pediatr. 2016 Apr;28(2):250-7. [PubMed: 26900921]

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Fernando I, Pritchard J, Edwards SK, Grover D. UK national guideline for the management of Genital Molluscum in adults, 2014 Clinical Effectiveness Group, British Association for Sexual Health and HIV. Int J STD AIDS. 2015 Sep;26(10):687-95. [PubMed: 25332225]

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Brown M, Paulson C, Henry SL. Treatment for anogenital molluscum contagiosum. Am Fam Physician. 2009 Oct 15;80(8):864. [PubMed: 19835348]

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Vakharia PP, Chopra R, Silverberg NB, Silverberg JI. Efficacy and Safety of Topical Cantharidin Treatment for Molluscum Contagiosum and Warts: A Systematic Review. Am J Clin Dermatol. 2018 Dec;19(6):791-803. [PubMed: 30097988]

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Olsen JR, Gallacher J, Piguet V, Francis NA. Development and validation of the Molluscum Contagiosum Diagnostic Tool for Parents: diagnostic accuracy study in primary care. Br J Gen Pract. 2014 Aug;64(625):e471-6. [PMC free article: PMC4111339] [PubMed: 25071059]

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Al-Dawsari NA, Masterpol KS. Cantharidin in Dermatology. Skinmed. 2016;14(2):111-4. [PubMed: 27319954]

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Singh A, Thappa DM, Hamide A. The spectrum of mucocutaneous manifestations during the evolutionary phases of HIV disease: an emerging Indian scenario. J Dermatol. 1999 May;26(5):294-304. [PubMed: 10380430]

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van der Wouden JC, van der Sande R, Kruithof EJ, Sollie A, van Suijlekom-Smit LW, Koning S.