Molluscum Contagiosum

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Molluscum contagiosum facts

  • A viral infection of the skin causes molluscum contagiosum, a mild skin disease.
  • Risk factors include direct and indirect contact with an infected person's skin.
  • Symptoms and signs include painless pinkish raised nodules or bumps on the skin.
  • A doctor's physical exam presumptively diagnoses most molluscum contagiosum infections; tissue biopsy offers a definitive diagnosis.
  • Molluscum contagiosum often requires no treatment as nodules resolve in about six to 12 months; however, cryotherapy (freezing), curettage (cutting out the lesions), laser therapy, or chemical treatments also may treat the nodules.
  • There are many home treatments available, but people should check with their doctor before using these treatments.
  • The prognosis of most molluscum contagiosum infections is excellent, but people with immune compromise have a more guarded prognosis.
  • There is no commercially available vaccine for molluscum contagiosum infections, but people can reduce their chances of getting the disease by avoiding direct and indirect skin contact with infected people.

What is molluscum contagiosum?

Molluscum contagiosum is a mild skin disease caused by a virus (molluscum contagiosum virus, a member of the Poxviridae family) that causes painless small bumps (flesh-colored, dome-shaped papules; some may be umbilicated, meaning the lesion has a central depression with a spot in the middle that resembles a navel) on the skin. The disease occurs worldwide but is more prevalent in warm, humid climates. The disease is usually not serious and, in most people, resolves in about six to 12 months without treatment. It is a common infection in children; direct person-to-person contact, sexual contact, and contaminated items like clothing, towels, or other objects may transmit the infection. Some consider it to be a sexually transmitted disease (STD), but many others simply consider it to be a skin disease that is contagious by any skin-to-skin and indirect incidental contact with the infecting virus.

The virus can infect all other parts of the body by autoinoculation (self-transfer of the virus to another area of the skin).

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Molluscum Contagiosum Symptoms and Signs

Bumps on the Skin

People often describe localized swollen areas on, or under, the skin as lumps or bumps. While bumps on, or under, the skin may result from conditions that give rise to a skin rash, many other conditions can result in solitary raised lumps on the skin. Infections, tumors, and the body's response to trauma or injury can all lead to lumps or bumps that appear to be located on or underneath the skin.

Picture of molluscum contagiosum

Is molluscum contagiosum contagious?

With part of its name being contagiosum, you can be sure it is contagious. The virus spreads by direct skin-to-skin contact and by indirect contact (for example, towels or personal items used in contact sports that an infected person touches, allowing the virus to pass from the towel or item to another person's skin).

What is the incubation period for molluscum contagiosum?

The average time from exposure to the development of symptoms (incubation period) is about two to seven weeks and may be as long as six months in some individuals.

How long does the infection with molluscum contagiosum last? When does a person become noncontagious?

The skin lesions last about six to 12 months although some individuals have had lesions last up to four years. Once the lesions spontaneously resolve, the person is not contagious. The contagious period is quite variable and depends on when the lesions resolve.

What causes molluscum contagiosum?

The cause is a virus, molluscum contagiosum virus, a member of the poxvirus family. The virus only survives in the skin, and when the lesions are gone, the person no longer is contagious.

What are risk factors for molluscum contagiosum?

The highest risk factor is when an uninfected person touches a skin lesion on an infected person's skin or contacts an item such as a towel that an infected person recently used. People with weakened immune systems are at risk for getting the infection and having it rapidly spread with larger lesions. Other people at high risk are wrestlers, swimmers, gymnasts, and people who use steam baths and saunas. It's also possible to transmit the infection sexually. It is theoretically possible to contract the virus from a toilet seat, though no one has documented this.

What are molluscum contagiosum symptoms and signs?

The first signs and symptoms of molluscum contagiosum are small painless papules (raised bumps or lumps) on the skin (molluscum lesions). It often appears as a raised, pearly pinkish nodule or redness on the skin; some nodules contain a dimple in the center. Most molluscum lesions are small, about 2-5 mm in diameter. Inside the nodule, sometimes there is a cheesy whitish core. The lesions may become itchy, sore, and reddened if scratched. The lesions can appear anywhere on the body (face, mouth, genital area, penis, or vagina, for example). The skin lesions may go through three stages; the first is a small whitish and/or reddish bump on the skin. Over a few weeks, the bumps can enlarge to about 2-5 mm with a whitish pus head that develops into a small crater when it bursts (stage 2; patients are advised not to attempt "popping" these pus-containing bumps or pimples). Stage 3 is when the burst craters develop into reddish sores; other organisms (secondary infections) may infect these open sores.

How do physicians diagnose molluscum contagiosum?

Doctors diagnose molluscum contagiosum based on the person's history and physical exam. A skin biopsy or tissue scraping that shows the viral infection is a definitive diagnosis usually made by a pathologist. This definitive diagnosis is sometimes helpful to distinguish molluscum contagiosum from many other skin conditions like herpes, genital warts (HPV), hives, atopic dermatitis, skin cancer, bacterial infections, or folliculitis.

What is the treatment for molluscum contagiosum?

Most people need no treatment because the lesions spontaneously disappear in about six to 12 months, although for a few, it may take up to four years. There are many treatment options. Discuss any treatment method with a doctor. Cryotherapy (freezing with liquid nitrogen), curettage (cutting out the lesions), and laser therapy may remove lesions. In addition, creams that include podophyllotoxin cream, salicylic acid, tretinoin (Retin A, Atralin, Renova, Avita, Altinac), and cantharidin may remove lesions. An antiviral medication (Valtrex) has been used treat the disease. Physicians may use cimetidine (Tagamet) to treat molluscum contagiosum in small children. A new medication, imiquimod (Aldara), helps to strengthen the skin's immune response and may help to get rid of the lesions in some people. Topical desonide cream (a low-dose corticosteroid) reduces any symptoms that may accompany scratching the nodules. Some physicians may treat the disease with topical anti-inflammatory medications like diclofenac gel.

What type of doctors treat molluscum contagiosum?

Although primary care providers and pediatricians can treat this disease, consultants like dermatologists, infectious disease specialists, and pathologists may provide consultations for diagnosis and treatment.

Are there any home remedies for molluscum contagiosum?

There is a wide range of home remedies available for this disease. People have tried remedies such as apple cider vinegar, tea tree oil, alcohol, iodine, hydrogen peroxide, elderberry extract, and duct tape occlusion. Unfortunately, there is little data to support these remedies although some claim to cure the disease. Some are easily available at pharmacies (for example, ZymaDerm). It is important to discuss the situation with your doctor before trying these remedies.

What is the prognosis of molluscum contagiosum?

Most people who get molluscum contagiosum have an excellent prognosis because the infection is usually self-limiting; it typically affects only the skin and resolves without treatment over about six to 12 months in most people. However, immunosuppressed people have a more guarded prognosis as the disease may persist for years and become widespread on the skin; some people may get secondary bacterial skin infections; the major complication of the disease. Some treatments listed above (cryotherapy, curettage, laser, and some chemical treatments) may leave small scars. Even if you get the disease and are cured, you can be reinfected and get the disease again.

Is it possible to prevent molluscum contagiosum?

It is possible to reduce the chance of getting the disease by avoiding any direct skin-to-skin contact with an infected person. Direct contact with items touched recently by an infected person (clothing, towels, and benches used in contact sports like football, for example) should also be avoided. Either not having sexual contact (genital or oral) or using condoms can prevent some individuals from getting the disease, but if the condom does not cover an infected area, it's still possible to infect a sex partner.

Medically Reviewed on 5/7/2018
References
REFERENCES:

American Academy of Dermatology. "Molluscum Contagiosum." <https://www.aad.org/public/diseases/contagious-skin-diseases/molluscum-contagiosum>.

United States. Centers for Disease Control and Prevention. "Molluscum Contagiosum: Transmission." May 11, 2015. <http://www.cdc.gov/poxvirus/molluscum-contagiosum/transmission.html>.
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