Introduction

Molluscum Contagiosum is a virus which can cause small red spots on the skin. This usually clears by itself without the need for any treatment.¹ 

Understanding molluscum contagiosum

Because Molluscum Contagiosum is so common, it is important that it is understood by both healthcare practitioners and the general public. This article will give you information about Molluscum Contagiosum, its diagnosis and treatment.

Cause of molluscum contagiosum

Molluscum Contagiosum is caused by a type of virus called the Molluscum Contagiosum Virus which only affects humans.²

What does molluscum contagiosum look like?

Molluscum Contagiosum causes lots of well-defined shiny red spots on the affected skin area. These bumps have a small dip at the top of the bump.^3,4

How does molluscum contagiosum spread?

Molluscum Contagiosum can be caught if your skin touches the skin of someone who already has the virus.¹

Incubation period 

Molluscum Contagiosum does not appear immediately after contact with an infected person. It can take 14 to 50 days for the bumps to appear on someone's skin. The bumps may be the only sign that you have Molluscum Contagiosum.⁵ 

How common is molluscum contagiosum?

• Molluscum Contagiosum is common worldwide, though it is more common in tropical climates and places where there are high levels of poverty, overcrowding, or low levels of hygiene
• Children are more likely to experience Molluscum Contagiosum than adults, with most cases in children between one to four years old though it's not uncommon for an adult to experience it
• People who are immunocompromised are also more likely to have Molluscum Contagiosum. In immunocompromised people, the bumps usually appear around the eyes⁶

Risk factors

Certain factors can increase the likelihood of catching Molluscum Contagiosum. It is useful to know these things as they can help you understand the risk of catching them and take precautions where necessary.

Molluscum Contagiosum is more common in people who have eczema, or people who go swimming. It has also been discovered that younger age, living in tropical areas, sharing close living quarters, making lots of skin contact with other people, and sharing clothes make it more likely that a person will catch Molluscum Contagiosum.⁷

Symptoms of molluscum contagiosum

Most people only notice the spots caused by Molluscum Contagiosum and do not report other symptoms. However, some people experience pain, itching, skin inflammation and skin redness. Even if you have itching caused by Molluscum Contagiosum, it is important to avoid scratching as this can cause the infection to spread.⁸

Commonly affected areas 

Some areas of the body are more prone to get infected with molluscum contagiosum than others. In children, the most commonly affected areas of the body are the arms and legs, the torso, or the face. In adults, the virus is more likely to be passed on via sexual contact and so the genitals and groin are the most commonly affected area.⁹

Diagnosis

Molluscum Contagiosum often goes away by itself without needing to be seen by a medical professional. However, getting diagnosed with Molluscum Contagiosum can be helpful if there are symptoms that are causing discomfort and to rule out other skin issues.

Clinical examination 

Molluscum Contagiosum is usually diagnosed by your GP. Your doctor will ask you about what's happening to your skin and then examine you. This examination may happen in a few ways:

• Your doctor will ask you to move the clothing from the affected area and examine your skin.
• Your doctor may use a microscope to look at your skin (dermoscopy) so they have a better view.
• They may take a small sample of your skin to be sent to a lab and examined to confirm that it is Molluscum Contagiosum.

You can have a family member or friend present during your appointment, and if you are uncomfortable you can stop the examination at any time.¹⁰

Differential diagnosis of molluscum contagiosum 

Several conditions can look similar to Molluscum Contagiosum, making accurate diagnosis important. These include warts (verruca vulgaris), which are rough and lack the central indentation seen in MC, and herpes simplex virus (HSV), which presents as painful clusters of blisters that may ulcerate. Sebaceous hyperplasia may also resemble MC, with small yellow bumps, usually on the face. Bacterial infections like furunculosis cause painful, pus-filled lumps. In immunocompromised individuals, conditions like cryptococcosis or histoplasmosis may present with similar umbilicated lesions. Tools like dermoscopy or biopsy are often used to distinguish these conditions and ensure proper treatment.

Secondary issues

Having Molluscum Contagiosum can lead to other issues which may cause problems. These can include:

• Conjunctivitis (a condition where the membrane that covers the white of the eye and inside of the eyelids becomes inflamed)¹¹
• Bacterial superinfection (when a bacterial infection is caught after a virus which has already infected someone)¹²

Treating molluscum contagiosum

Molluscum Contagiosum does not normally need treatment as it normally goes away by itself, but it is necessary in some cases.

Prevention

People with Molluscum Contagiosum should be aware that it is contagious, and therefore avoid swimming pools, sharing towels with other people within the household, and using protection during sexual intercourse.

Creams

Sometimes the skin can become sore or itchy due to Molluscum Contagiosum, and in these cases, your GP may prescribe steroid cream and/or antihistamines for this.

Antibiotics

If your Molluscum Contagiosum-affected skin has become "superinfected" (infected by bacteria as well as the Molluscum Contagiosum virus) then your GP may prescribe antibiotics, warm compresses, and drainage of any fluid that builds up.¹³

Other forms of treatment include: 

1. Cantharidin, a chemical can be used to treat the affected area. This can cause short-term pain or blisters in some people but has achieved good results in clearing the infection and low chance of scarring post-treatment. This treatment usually takes between one to three applications. It should never be performed on the face, and it is recommended that Cantharidin is tested on one or two lesions before treating all of them to make sure the patient does not suffer a bad reaction¹⁴
2. Cryotherapy: Another possible treatment is freezing the Molluscum Contagiosum. A cotton bud soaked in liquid nitrogen is applied to the bumps for six to ten seconds and a follow-up appointment after three weeks may be required
3. Curettage is a procedure where the bumps are removed by a doctor scraping them away with an instrument. This is rarely done as it can be quite uncomfortable
4. Salicylic Acid, a gel made of salicylic acid may be used to treat the Molluscum Contagiosum bumps. This is sometimes avoided when the patient is a person of colour, as they may find that the area of skin where this gel is applied becomes lighter after treatment
5. Evisceration is a method where the bump is pierced and its contents removed, though young children may not be willing to have this done to them
6. Tape Stripping is a method where the adhesive tape is pressed onto the bumps and then pulled away over and over again 10-20 times. This removes the top layer of the bump which can help the issue to clear - however, the tape used can actually spread the virus to other parts of the skin and therefore this method is not often recommended
7. Tretinoin cream can be put on the bumps twice per day to help get rid of the bumps, which usually clear after eleven days though this method should not be used by people who are pregnant or may be pregnant
8. Potassium Hydroxide: washing the bumps with Potassium hydroxide to break down the bumps has been found to help resolve the issue. However, it can cause changes to skin pigment and scarring
9. Imiquimod Cream can be applied before bed for four weeks to treat the Molluscum Contagiosum virus. Side effects include skin irritation

Psychological impact

Skin issues can affect the quality of life of the individual suffering from them, so they need to be managed well to prevent negative impact on the patient's everyday experience and their mental health.¹⁵

The families and carers of people with skin conditions can also be affected. Caring for someone with a skin issue can be complex, and help from family members is vital to treating skin problems. Your healthcare team will always be there to support you if you or a loved one has a skin problem.

Conclusion

Molluscum Contagiosum is a common problem, especially for children. It normally goes away by itself without treatment. However, if it is causing problems like pain, irritation or redness, or the person with Molluscum Contagiosum is immunocompromised, they must be seen by a doctor. Treatments are available for Molluscum Contagiosum. If it is affecting your quality of life or does not go away by itself within 18 months, do make an appointment with your doctor.