Nili N. Alai, M.D., FAAD
What is Molluscum Contagiosum?
Molluscum Contagiosum is a common skin disorder which is caused by a superficial skin infection with the poxvirus. Molluscum bumps appear as multiple, scattered, small tan or pink little bumps on any part of the skin including the neck, trunk, arms, legs, buttocks, and face. Although it is primarily a skin condition of children, molluscum contagiosum is less frequently seen in adults. More males seem affected than females. Most people have no symptoms while others may have some associated itching. The molluscum virus does not affect internal organs or enter the blood stream.
As the name implies, molluscum contagiosum is very contagious and easily transmitted from person to person via skin or fomites. Molluscum is often cosmetically displeasing but otherwise medically harmless. Most people have a few bumps 2-3 months before seeking treatment. Molluscum is typically seen in otherwise healthy young children and adults. HIV/ AIDS patients may have hundreds of molluscum bumps. Untreated, molluscum may spread to other body parts and to other people. Many cases of molluscum may resolve over months to years spontaneously without any treatment. Molluscum is typically treated with common wart remedies like liquid nitrogen (freezing) or burning (cautery).
Who gets molluscum contagiosum?
Anyone can get molluscum contagiosum anywhere on the body, except on the palms and soles. Children are most prone because of an immature or underdeveloped immune system.
- Healthy children
- Sexually active adults
- Healthy adults
- People with a compromised immune system
Certain groups of people are more prone to molluscum infections. People with a compromised immune system like in HIV/AIDS, hepatitis, chronic illnesses, cancer, systemic chemotherapy, immunosuppressive drugs like prednisone, and those on biologic immune system modifying drugs like Remicade or Enbrel may be more prone to Molluscum contagiosum.
Molluscum is also more common in wrestlers; people involved in close contact sports, children in daycare, and sexually active young adults.
What does molluscum contagiosum look like?
Pictures of molluscum show very small (often the size of a typical pimple or pinhead) smooth, flesh colored bumps scattered on an arm or leg.
Close up molluscum photos show the telltale sign, which is a shiny, smooth, skin colored bump with a central dell or pinhead sized opening.
Molluscum bumps are often localized on one body area like the face or trunk, but may also spread to multiple body areas. Often, anywhere from 1-30 very small slightly smooth bumps are scattered on the skin. Some of the bumps may be slightly red or have an accompanying light-red, dry, itchy rash indicating inflammation.
Sometimes, squeezing the molluscum bump (like a pimple) reveals a small white core that pops out. The central core is often white or tan and may look just like a typical whitehead. People may think they just have acne and complain of new onset small red bumps and “acne” on their skin.
- Smooth, tan or pink pearly bumps scattered on the body
- Size ranges from commonly 1-2mm (pinhead) to rarely 10mm ( bigger than pencil eraser)
- Central dell or pin head opening
- Shape is typically perfectly round
- Small white cheesy center that pops out
What is the prognosis with molluscum contagiosum?
The prognosis is very good. Overall, molluscum contagiosum tends to be an easily treated and curable skin disease. Molluscum may clear on its own without treatment over a few months to five years. More widespread, atypical cases of molluscum may be cosmetically disfiguring and psychologically distressing for the individual.
- Good prognosis
- Easily treatable
- Multiple treatments
Does molluscum contagiosum affect the entire body?
Although possible, it is extremely rare to have it all over the body in a healthy individual with a normal immune system. Molluscum contagiosum most characteristically involves just one or two body areas at a time like the chest, back, or legs. Other common locations include the face, neck, eyelids, thighs, genitals and buttocks. It generally spares the palms and soles.
What causes the small bumps in molluscum contagiosum?
The bumps arise from the poxvirus infection of the upper layers of the skin. The skin may have some dilation of the small superficial blood vessels and inflammation, thereby giving the bumps a red or flushed appearance.
How is molluscum contagiosum contracted?
Molluscum is most commonly transmitted via direct skin-to-skin contact. It may be transmitted through the use of fomites like razors or towels, public swimming pools, shared bathtubs, or hot tubs. Untreated, molluscum may spread to other body parts and to other people.
It is also contracted sexually by skin-to-skin contact in the genital area.
Not everyone who is exposed to molluscum becomes infected and develops the skin bumps. Some people are simply more prone to developing molluscum contagiosum because of their overall health, possible altered immune status, exposure history, and other predisposing skin conditions like eczema or severely dry skin.
Is molluscum contagiosum contagious?
As the name implies, molluscum contagiosum is very contagious and easily spread between people.
Is molluscum contagiosum curable?
Most cases of molluscum contagiosum are easily and fully curable. There are very rare, long-standing cases of molluscum contagiosum in immunocompromised people that may not be curable.
How is molluscum contagiosum diagnosed?
The diagnosis of molluscum is typically straightforward based simply on the skin appearance. Most pediatricians and family physicians diagnose this condition during a simple, in-office skin exam.
A few other medical conditions may look just like molluscum and need to be examined more closely by a physician specializing in conditions of the skin called a dermatologist. A dermatologist may therefore be consulted for atypical cases of molluscum.
While typical cases do not require special tests, cases that are more difficult may warrant a relatively painless, in-office, skin scraping by a dermatologist using a microscope, glass slide, and potassium hydroxide to rapidly detect the small poxvirus particles. Rarely, a small skin biopsy may be used to help the doctor confirm the diagnosis.
- Physical exam with your doctor
- Skin scraping and microscopic exam
- Skin biopsy
Other times, a skin bacterial culture may be taken by a cotton tip applicator to assist in determining a secondary skin infection like with staphylococcus.
What else does molluscum contagiosum look like?
Other skin conditions can mimic molluscum including:
- milia (whiteheads)
- fungal infection like cryptococcus or histoplasma
- boils (furuncles)
- atopic dermatitis
- contact dermatitis
- bug bites
- heat rash (miliaria)
- basal cell carcinoma
- keratoacanthoma (variant of squamous cell carcinoma)
What is the cause of molluscum contagiosum?
Molluscum is caused by a skin infection with the poxvirus. It is not caused by bacteria, yeasts, or fungi.
Why do I keep getting more molluscum bumps where I shave?
The repeat tiny cuts caused by shaving with a razor create more potential openings for the poxvirus. This may lead to further spreading of molluscum. Treatment goals include avoiding shaving the affected molluscum area and trial of other hair removal methods like laser hair removal, electric razors, or cream depilatories like Neet or Nair.
What are possible complications of molluscum contagiosum?
Complications are infrequent since molluscum is usually a self-limited skin condition. Rarely, the bumps may enlarge causing an abscess (furuncle or carbuncle), or painful cysts requiring minor surgical drainage. Eczema or skin irritation around the molluscum areas, particularly in people with a history of eczema or atopic dermatitis, is common. Deeper or more extensive skin infections called cellulitis can be a rare complication.
- Abcess or cyst
- Skin infection
- Rash or eczema
- Skin discoloration
Another potential complication includes temporary skin discoloration called post-inflammatory hypopigmentation (lighter than the regular skin color) or hyperpigmentation (darker then the regular skin color). This altered skin color may occur after the inflamed, red bumps have improved or after certain treatments.
Permanent scarring in uncommon but may occur from picking, overly aggressive treatments, scrubbing, or other deep inflammation.
What lab tests help diagnose molluscum contagiosum
Usually, no specific laboratory tests are needed in the diagnosis of common molluscum. Studies like blood tests and x-rays are not useful.
A microscopic test of a skin scraping using potassium hydroxide may help to confirm the diagnosis. Skin biopsy (surgically taking a small piece of skin using local numbing medicine) with histopathological (exam of tissue under the microscope) evaluation may be useful in atypical or widespread cases. Sometimes skin biopsies help to exclude other possible diagnosis.
Does diet have anything to do with molluscum contagiosum?
Overall, diet does not seem to affect molluscum.
How do I treat molluscum contagiosum?
There are many good treatment options for treating molluscum. Some individuals and physicians may also suggest not treating the molluscum and allowing it to go away on its own. The specific treatment depends on the areas involved, number of bumps, age of the individual, and other health conditions.
Many available wart treatments are also used to treat molluscum. It is very important to keep in mind that regardless of the treatment, multiple and repeat treatments may be required to get rid of all of the molluscum. Treatments should be scheduled every 2-3 weeks for best results.
Home remedies for mild cases of molluscum include one or a combination of the following:
- Use of an over-the-counter salicylic acid patch like Trans-ver-sal or Compound W
- Self freezing every 2-3 weeks with an over-the counter home wart freezer device
- Daily application of a very small piece of duct tape or electrical tape applied to the individual molluscum bumps
- Squeezing out the small center core of each bump
Professional medical treatments may include one or a combination of the following:
- Freeze with liquid nitrogen, called cryotherapy
- Burn using light electrocautery
- Painlessly apply cantharidin “beetle juice” or “blister beetle fluid”
- Manually extract the core using a special tool called a comedone extractor
- Apply chemical acid
- Surgically remove using a small, sharp, spoon-like instrument called a curette
- Apply daily retinoid like Retin A or Tazorac cream at home
- Apply topical immune activating medications like imiquimod (Aldara) cream
- Apply topical chemotherapy cream like 5-fluorouracil (Efudex or Carac)
- Apply topical antiviral medications like new Cidofavir cream ( off-label use)
- Take oral cimetidine (Tagamet) used for weeks to months for individuals with a large number of lesions( off-label use)
- Use laser therapy in some cases
How do I treat the rash with molluscum?
Treatment of molluscum-associated eczema should address the underlying dry skin. General measures to prevent excessive skin dryness and breakdown such as using mild soap-less cleansers are recommended. Lubrication with moisturizer lotions such as Cetaphil or Lubriderm is helpful for many people. Eczema that is more resistant may require the addition of an over the counter hydrocortisone cream like Cortaid or a prescription medium potency topical steroid cream like triamcinolone once or twice a day for inflamed or itchy areas. Topical steroids should not be applied directly to the molluscum bumps and may in fact worsen molluscum.
- Gentle soap-less cleanser
- Skin lubrication
- Hydrocrotisone cream
How do I treat the persistent skin discoloration after molluscum?
After the molluscum bumps have resolved, persistent skin discoloration called hyperpigmentation may be left alone and allowed to resolve over time. Alternatively, residual hyperpigmentation may be treated with prescription fading creams like hydroquinone 4%, kojic acid, or azelaic acid 15-20%. Over the counter fading creams with 2% hydroquinone may be available like Porcelana. Specially designed prescription creams for particularly resistant skin discoloration using higher concentrations of hydroquinone 6%, 8%, or 10% with a retinoid and a topical steroid may also be formulated by compounding pharmacists. Mild chemical peels and microdemabrasion may also help improve discoloration.
- Hydroquinone cream
- Azelaic acid
- Kojic acid
- Chemical peels
How do I prevent Molluscum Contagiosum?
Prevention efforts include:
- Practice good skin hygiene
- Avoid skin contact with infected individuals
- Avoid unsanitary hot tubs and public pools
- Do not share razors, towels, or clothing with others
Molluscum Contagiosum at a Glance
- Very common, contagious, benign skin disorder
- Caused by poxvirus
- Often seen in otherwise healthy people
- Commonly affects children and sexually active adults
- Typically on the trunk arms, and legs
- Looks like scattered, small, smooth tan or pink bumps
- Easily curable in most cases
- Sometimes clears on its own without treatment
- May require multiple treatments and ongoing maintenance therapy
- Often treated with freezing with liquid nitrogen
- Prevented by good skin hygiene
Dr. Gary Cole and Dr. Nili Alai are Board-Certified Dermatologists.
For more information, please call (949) 582-7699 or visit the practice website at www.lagunaskincenter.com.
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