FFinalistSouthampton · 2027
Dermatology
AKT · Dermatology/Infections & infestationslow yield

Molluscum contagiosum

Molluscum contagiosum virus (a poxvirus)

Overview

A common, self-limiting poxvirus infection producing pearly, dome-shaped, umbilicated papules. Usually in children (skin contact) or as a sexually transmitted lesion in adults. Reassurance is the mainstay — it self-resolves over months.

Recognise

  • Multiple small (2–5 mm), pearly/skin-coloured, dome-shaped papules with a central dimple (umbilication)
  • Spreads by skin contact and autoinoculation (often grouped, can Koebnerise); a surrounding eczematous reaction is common
  • Widespread/atypical or facial in an adult → consider HIV/immunosuppression

Red flags

  • Numerous, large or facial mollusca in an adult → test for HIV/immunosuppression

Differentials & how to tell them apart

Viral wartsrough hyperkeratotic surface, no central umbilication
Basal cell carcinomaa solitary pearly papule with telangiectasia in older sun-damaged skin — biopsy if in doubt
Disseminated cryptococcosis/HIVmolluscum-like facial papules in advanced HIV — atypical, immunosuppressed

Clinical image

We can't host this one — the image is DermNet's and their licence doesn't cover us republishing it. Their page for it is free to view.

Molluscum contagiosum — clinical imagesDermNet

Investigations

Clinical diagnosis (the central umbilication is characteristic).

Management

Reassurance — self-limiting; avoid sharing towels and squeezing lesions

  1. 1Reassure: molluscum self-resolves over 6–18 months without scarring. Avoid sharing towels/baths, do not squeeze/scratch (autoinoculation); treat any surrounding eczema.Gate: Numerous, large, or facial molluscum in an ADULT is a flag for HIV/immunosuppression → consider HIV testing rather than just treating the spots
  2. 2Treatment is rarely needed; if wanted for troublesome lesions → cryotherapy or topical agents (specialist/older child); genital lesions in adults → sexual health review.
No treatment / reassurance — first-line — self-limiting over 6–18 months
Treat associated eczema — emollient ± mild topical steroid for the surrounding dermatitis

Key points

Self-limiting — the right answer is usually reassurance. Adults with genital lesions should be seen in sexual health; widespread facial disease suggests immunosuppression.

Monitor & prognosis

Spontaneous resolution.

Resolves spontaneously without scarring.

Source: NICE CKS Molluscum contagiosum; DermNet