Molluscum contagiosum
Also called molluscum, water warts
A poxvirus growing pearls: smooth, dome-shaped, umbilicated papules scattered where children's skin touches skin, water, and towels. Harmless and self-resolving over months, which the consultation is really about explaining.
How it looks
Multiple discrete, pearly, dome-shaped papules with central umbilication clustered over the trunk and flexures of a child.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
The pearly translucency is less evident in deeply pigmented skin, where lesions look skin-coloured to hyperpigmented and resolve with more conspicuous pigment change; the central dell under side-lighting remains the reliable sign.
Don't miss
Hundreds of large or facial mollusca in an adult without obvious reason is an immunosuppression flag, HIV testing included.
Symptoms & course
- Usually asymptomatic
- An eczematous ring around lesions ('molluscum dermatitis') itches
- Inflamed, red lesions usually mean the immune system is winning, not infection
Diagnostic approach
- Clinical; dermoscopy shows the central pore and lobular white structures when in doubt
Differential, and how to separate them
- Viral warts
Favours it: Multiple papules in a child
Against it: Warts are rough and keratotic; molluscum is smooth with a central dell
- Herpes simplex
Favours it: Umbilicated vesicular-looking lesions
Against it: HSV is painful, clustered at one site, and evolves in days; molluscum is indolent for months
- Varicella (chickenpox)
Favours it: Scattered papules in a child
Against it: No fever, no crops, no simultaneous stages, and molluscum lesions last months not days
Management principles
- Reassurance and time is first-line in children
- Treat the itchy dermatitis around lesions like the eczema it is
- Curettage, cantharidin, or cryotherapy when treatment is genuinely wanted; screen sexual partners in adult genital disease
Clinical pearl: The inflamed, angry molluscum that parents bring in urgently is usually the beginning of the end: immune recognition, not superinfection.
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