What is molluscum contagiosum?

Molluscum contagiosum, also known as water warts,⁹ is a viral infection caused by the molluscum contagiosum virus (MCV), a member of the poxvirus family.¹⁰ It is characterised by small raised papules (bumps) with a central dimple or umbilication.⁸ The bumps, often referred to as "water warts," are benign and typically resolve on their own within a few months to a couple of years without requiring treatment.¹

Athletes, especially those engaged in contact sports like wrestling, are particularly susceptible to molluscum contagiosum due to frequent skin-to-skin contact and exposure to shared equipment and facilities.⁸ 

Symptoms of molluscum contagiosum in athletes?

The symptoms of molluscum contagiosum in athletes include:

• A single lesion or a cluster of pearly bumps²
• Flesh-coloured, white, pink, or purple bumps
• Round and raised⁵ bumps that are firm initially but may soften over time
• Bumps that often have a central dimple (indent)⁴
• Itchiness⁵
• Redness around the edges⁴
• Shiny papules usually under 6mm in diameter⁵
• Location of the bumps depend on the sport engaged in, such as the face, neck, trunk, and arms for wrestlers¹⁶

*lesion: abnormal or damaged tissue caused by injury, infection, or disease.

How is molluscum contagiosum diagnosed in athletes?

Diagnosis is typically made through clinical examination, based on the characteristic appearance of the lesions.⁶ In cases of uncertainty, a sample of the lesion and examining it under a microscope. 

Differential diagnosis

Conditions that may resemble molluscum contagiosum include:^10,11

• Acne vulgaris
• Common warts (verruca vulgaris)
• Genital warts (condyloma acuminatum)
• Lichen planus
• Herpes simplex
• Chickenpox (varicella-zoster)
• Folliculitis
• Milia
• Keratoacanthoma
• Basal cell carcinoma

How do you treat molluscum contagiosum in athletes?

While molluscum contagiosum is usually self-limiting, athletes require regular screening and prompt treatment to minimise the risk of outbreaks and prevent disruptions in team practices and competitions.¹² The physician will determine the appropriate treatment for molluscum contagiosum after examining the patient. Some treatment options include:^1,6,7

• Tretinoin cream
• Benzoyl peroxide
• Salicylic acid
• Imiquimod cream
• Cantharidin solution (beetle juice)
• Needle electrosurgery
• Curettage
• Pulsed dye laser (PDL)
• Cryotherapy

Self-management tips 

• Avoid shaving over bumps to prevent spreading
• Take cool baths and use unscented moisturisers to alleviate itchiness and reduce dryness¹
• Cover the bumps during practices with clothing or medical bandages to prevent transmission
• If a molluscum contagiosum bump breaks, clean it with warm water and soap. Apply a thin layer of antibiotic cream to prevent the spread of the virus and reduce the risk of secondary bacterial infection⁴

When to seek medical attention

Immediate medical attention is required if:⁴

• The lesion becomes painful to touch (tender)
• The athlete develops a fever
• Increase in redness surrounding the bump
• Continuous drainage from the bump

Specialist referral may be necessary for molluscu near the eye, genital area, or in athleted with weakened immune systems or chronic eczema.¹

What is the prognosis for molluscum contagiosum?

The prognosis for molluscum contagiosum is generally excellent, with the lesions typically clearing up within eighteen months even without treatment.¹ In some cases, the bumps may persist for longer periods.⁸ They typically do not scar on healing but may discolour if excessively scratched. 

Removal of the bumps through procedures like cryotherapy may carry a risk of secondary infections or scarring.⁶ In the event of an infection, antibiotics will be prescribed. 

Prognosis and complications

However, athletes should take care to avoid scratching the papules, as this can lead to several complications:¹²

• Spreading the virus to surrounding skin areas, resulting in new lesions appearing in a line (known as crops)
• Forming breaks in the skin barrier, increasing the risk of a secondary bacterial infection and abscess formation
• Inflaming the surrounding skin, causing redness, swelling, and pain

To avoid complications and disruption in practice, athletes are advised to treat bumps promptly using cryotherapy or other procedures.

What are the risk factors for developing molluscum contagiosum in athletes?

Athletes are at at higher risk due to several factors:^12,13

• Close skin-to-skin contact, especially wrestlers¹⁵
• Exposure to contaminated surfaces like locker room floors
• Frequent exposure to wet environments, such as pools or saunas, where the virus thrives
• Sharing sports equipment, often without adequate disinfection
• Sharing exercise mats or sports gear such as baseball gloves and pads¹⁴
• Higher risk of injury and breakage in the skin barrier

General risk factors:

• Personal history of atopic dermatitis
• Weakened immune system, such as from cancer treatment or conditions like acquired immunodeficiency syndrome (AIDS)

Preventing molluscum contagiosum?

To prevent contracting and spreading molluscum contagiosum, athletes must follow precautionary measures:

1. Swimming pools are often hotspots for contracting molluscum contagiosum due to the virus's contagious nature and its ability to thrive on wet surfaces.³ Always remember to cover the bumps with waterproof bandages when swimming
2. Molluscum contagiosum spreads through close skin-to-skin contact (including sexual contact) and touching objects that are contaminated with the virus. Taking the following steps helps to prevent contracting the virus and reduces the risk of reinfection:^7,1,10,12
   • Examine athletes carefully for bumps, before practice and competitions
   • Promptly treat athletes with molluscum lesions and keep lesions covered with a bandage to minimise the risk of spreading the virus
   • Avoid direct contact with the lesions of an infected athlete
   • Wash hands after using shared exercise equipment
   • Regularly disinfect sports equipment and facilities
   • Avoid sharing or borrowing razors, towels, bedding, and other personal items
   • Refrain from squeezing or scratching the lesions, as this can lead to infection and scarring
   • Use a condom during sexual activity to reduce the risk of transmission¹
   • Create awareness among coaches and athletes about the condition

Summary

Molluscum contagiosum is a common skin infection caused by the molluscum contagiosum virus (MCV), belonging to the poxvirus family. It causes the development of round, raised papules (bumps) that can be white, pink, purple, or flesh-coloured. These bumps are typically smaller than 6 mm in diameter, often with a central umbilication, and can occur singly or in clusters.

Molluscum contagiosum is commonly seen in athletes engaged in contact sports, particularly wrestlers. The diagnosis is primarily clinical, based on the appearance of the lesions. Confirmation during uncertainty may involve examining the scrapings from the lesion under a microscope.

Molluscum contagiosum is usually self-limiting, with lesions typically resolving within eighteen months without intervention. However, athletes require prompt treatment to prevent molluscum outbreaks and disruptions in team practices and competitions. Covering lesions with medical bandages is recommended to minimise the spread of the virus, particularly for swimmers who should use waterproof bandages. Scratching lesions also increases the risk of secondary bacterial infection and may lead to the formation of new lesions. A wide range of treatment options exist, such as benzoyl peroxide, laser therapy, cryotherapy, and curettage. 

Preventative measures include avoiding the sharing of towels, clothing, razors, and other personal items. Athletes should prioritise good personal hygiene, including thorough handwashing with soap and water following sports activities and regularly disinfecting sports equipment to mitigate the spread of molluscum contagiosum.