Molluscum Contagiosum

The classic lesion is a small (one to five millimeters), firm, dome-shaped, flesh-colored or pearly white bump with a tiny central indentation, called central umbilication. Lesions usually appear in clusters, often on the trunk, armpits, neck, arms, legs, and groin. In children they may involve the face. In adults with sexually transmitted disease, lesions appear on the genitals, lower abdomen, and inner thighs.

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The bumps are usually painless but can become red, swollen, and crusty as they near resolution; this BOTE sign (beginning of the end) signals immune recognition and is a good thing despite looking worse. Surrounding eczema-like patches are common, especially in children with atopic dermatitis, and scratching spreads the virus to new sites through auto-inoculation.

Molluscum contagiosum virus, a member of the poxvirus family, infects the top layer of skin and produces the bumps. Transmission happens through direct skin contact, shared towels, sponges, wrestling mats, and pool toys, and through sexual contact in adults. The incubation period is two weeks to six months, so children can pick it up well before parents notice anything.

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Children with eczema are more susceptible because their skin barrier is impaired and scratching spreads the virus widely. People with weakened immune systems, including those with HIV or on immunosuppressive therapy, can develop large numbers of lesions, sometimes very large ones, that are harder to clear and may need more aggressive treatment.

Cantharidin (beetle juice) is a topical agent applied in the office to individual lesions. It raises a controlled blister beneath each bump that lifts it off over the next several days. Application is painless, which makes it the most child-friendly option. Treatment is usually repeated every three to four weeks until the lesions clear.

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Curettage uses a small spoon-shaped instrument to scrape lesions away after numbing cream, and is fast and effective for older children and adults but can be uncomfortable. Cryotherapy with liquid nitrogen is another in-office option. Topical retinoids such as tretinoin or tazarotene, imiquimod, and salicylic acid are sometimes used for slow-resolving cases. Berdazimer 10.3 percent gel (Zelsuvmi) is the newest FDA-approved topical, applied at home daily for up to twelve weeks.

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For adults with genital molluscum, treatment options include cryotherapy, curettage, cantharidin, and topical agents, and we discuss screening for other sexually transmitted infections and partner notification. For immunosuppressed patients with extensive disease, additional treatments and addressing the underlying immune status are part of the plan.

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Many parents elect to treat itchy or eczema-related lesions, those in visible areas, or those that are spreading, while watchful waiting is reasonable for a small number of lesions in a comfortable child without classroom or sibling spread issues.

For children, we make the visit as comfortable as possible. Cantharidin is painless to apply, and we let parents know what to expect: small blisters develop within 24 hours, the bumps look worse before they look better, and we cover the treated area for four to six hours afterward. We schedule follow-up every three to four weeks until the lesions are gone, which usually means three to five visits.

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For adults receiving curettage, lesions are numbed with topical anesthetic cream applied 30 to 60 minutes ahead of time, then removed in a few minutes. Mild redness and small scabs heal over a week.

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New molluscum lesions can appear during treatment because of the long incubation period, so extra sessions are sometimes needed. Once the immune system recognizes the virus, all lesions tend to resolve over a few weeks. Avoid swim lessons, contact sports, and shared baths during active infection to limit spread.

Make an appointment if your child has bumps that fit the description and they are spreading, itchy, near the eyes, or causing concern in childcare or school. Adults should be seen for any new genital bumps, for atypical or unusually large lesions, or if lesions are not resolving after a few months.

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People with weakened immune systems should be seen promptly because more aggressive disease is common and warrants tailored treatment.

Limit skin-to-skin contact while lesions are present. Cover lesions with clothing or a bandage during sports and swim lessons, do not share towels, washcloths, or razors, and have each family member use their own bath toys and sponges. Treat eczema actively, since intact skin is much harder for the virus to enter and scratching is what spreads it most.

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Avoid picking, popping, or scratching the bumps, which spreads virus to new sites. After treated lesions resolve, watch for new ones over the following weeks because of the long incubation period. Regular hand washing, especially after touching affected skin, helps limit spread to other parts of the body and to other people.