Molluscum contagiosum

Background
  • Self-limited skin condition caused by Molluscum Contagiosum Virus, member of poxvirus family
  • Most common in children 0-14 years of age [1]
    • Also affects sexually active adults and immunocompromised patients[2]
  • Transmitted via direct contact (including sexual contact) or fomites
Molluscum contagiosum lesions on an arm
Molluscum contagiosum at higher magnification

Clinical Features
  • Begins as painless, small papule
  • Becomes raised, pearly, flesh-colored dome with central umbilication (called "mollusca")[2]
    • Cental umbilication contains plug of virus-filled white caseous material.
    • Can be solitary or multiple
    • Can affect any part of the body
      • Genital mollusca on pediatric patients should prompt concern for child abuse
        • Auto-innoculation is also possible[3]

Differential Diagnosis

Pediatric Rash

Evaluation
  • Clinical diagnosis, based on history and physical examination
  • Biopsy with histology can confirm diagnosis if unclear

Management
  • Hygiene is key to reduce spread
    • Ensure adequate hand-washing
    • Wash all clothes in warm water
    • Avoid touching the area
    • Avoid sharing towels or clothing
  • Self-limited - no specific treatment necessary
    • Lesions resolve within 6-18 months in immunocompetent patients[2]
    • Treatment may be warranted in immunocompromised patients, for cosmesis, or to prevent autoinnoculation
  • Treatment options[2]
    • Cryotherapy - liquid nitrogen, dry ice
    • Scrub with betadine or retin-A 0.025% gel for 5 minutes daily
    • Surgical excision (may cause scarring)
    • PO antivirals (e.g. Cidofovir)

Disposition
  • Discharge

See Also

References
  1. Olsen JR, Gallacher J, Piguet V, Francis NA. Epidemiology of molluscum contagiosum in children: a systematic review. Fam Pract. 2014 Apr;31(2):130-6. doi: 10.1093/fampra/cmt075.
  2. Nandhini G, Rajkumar K, Kanth KS, Nataraj P, Ananthakrishnan P, Arunachalam M. Molluscum Contagiosum in a 12-Year-Old Child – Report of a Case and Review of Literature. Journal of International Oral Health : JIOH. 2015;7(1):63-66.
  3. Zhuang K, Ran Y, Xu F, Lama J. Atypical infantile genital Molluscum contagiosum. Anais Brasileiros de Dermatologia. 2015;90(3):403-405. doi:10.1590/abd1806-4841.20153298.
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